Provider Demographics
NPI:1992208128
Name:BROSSMANN, MEAGAN VICTORIA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MEAGAN
Middle Name:VICTORIA
Last Name:BROSSMANN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:MEAGAN
Other - Middle Name:VICTORIA
Other - Last Name:PALERMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:18751 NW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-3284
Mailing Address - Country:US
Mailing Address - Phone:954-297-1368
Mailing Address - Fax:
Practice Address - Street 1:1 OAKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-1956
Practice Address - Country:US
Practice Address - Phone:954-925-3844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225X00000X
FL19068225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024898700Medicaid