Provider Demographics
NPI:1942072640
Name:REILLY, MEGAN (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:REILLY
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 1:22691 LAMBERT ST STE 502
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1614
Mailing Address - Country:US
Mailing Address - Phone:949-273-6503
Mailing Address - Fax:
Practice Address - Street 1:22691 LAMBERT ST STE 502
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1614
Practice Address - Country:US
Practice Address - Phone:949-273-6503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist