Provider Demographics
NPI:1245841519
Name:KOYLE, MEGAN S (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:S
Last Name:KOYLE
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 1:6944 W GRUNDER ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-2921
Mailing Address - Country:US
Mailing Address - Phone:208-221-9230
Mailing Address - Fax:
Practice Address - Street 1:101 S ALLUMBAUGH WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-5658
Practice Address - Country:US
Practice Address - Phone:208-323-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-2212225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist