Provider Demographics
NPI:1184052409
Name:BRUMMETT, MEGEN ANNE BLAESING (MSOT, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MEGEN
Middle Name:ANNE BLAESING
Last Name:BRUMMETT
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:MISS
Other - First Name:MEGEN
Other - Middle Name:ANNE
Other - Last Name:BLAESING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOT, OTR/L
Mailing Address - Street 1:2839 BISHOP CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LYNCH STATION
Mailing Address - State:VA
Mailing Address - Zip Code:24571-2445
Mailing Address - Country:US
Mailing Address - Phone:434-941-8185
Mailing Address - Fax:
Practice Address - Street 1:101 LEROY BOWEN DR
Practice Address - Street 2:SUITE A
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-5093
Practice Address - Country:US
Practice Address - Phone:434-239-6630
Practice Address - Fax:434-239-6640
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005110225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics