Provider Demographics
NPI:1922364892
Name:REYES, MEGHAN M (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:M
Last Name:REYES
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 560202
Mailing Address - Street 2:
Mailing Address - City:MONTVERDE
Mailing Address - State:FL
Mailing Address - Zip Code:34756-0202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17701 8TH ST
Practice Address - Street 2:
Practice Address - City:MONTVERDE
Practice Address - State:FL
Practice Address - Zip Code:34756
Practice Address - Country:US
Practice Address - Phone:770-328-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14832225X00000X, 225X00000X
VA0119005518225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109410000Medicaid