Provider Demographics
NPI:1265904452
Name:HAZEL, MEGAN (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:HAZEL
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 1:414 SE DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-4247
Mailing Address - Country:US
Mailing Address - Phone:816-589-7879
Mailing Address - Fax:
Practice Address - Street 1:414 SE DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-4247
Practice Address - Country:US
Practice Address - Phone:816-589-7879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS17-03502OtherKANSAS STATE BOARD OF HEALIN ARTS
410662OtherNATIONAL BOARD FOR CERTIFICATION IN OCC
MO2018040576OtherBOARD OF OCCUPATIONAL THERAPY OF MISSOURI