Provider Demographics
NPI:1003419029
Name:MARTIN, MEGAN ELISABETH (OTR/L)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELISABETH
Last Name:MARTIN
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 1:1 WILLOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-5107
Mailing Address - Country:US
Mailing Address - Phone:413-887-9005
Mailing Address - Fax:
Practice Address - Street 1:1 WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302-5107
Practice Address - Country:US
Practice Address - Phone:413-887-9005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist