Provider Demographics
NPI:1922599315
Name:ST. AMANT, MAEGAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MAEGAN
Middle Name:
Last Name:ST. AMANT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 NORTHTOWN DR STE 110
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-3047
Mailing Address - Country:US
Mailing Address - Phone:601-206-9195
Mailing Address - Fax:601-957-8391
Practice Address - Street 1:680 BAY COVE DR
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-5551
Practice Address - Country:US
Practice Address - Phone:601-206-9195
Practice Address - Fax:601-957-8391
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT3465225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist