Provider Demographics
NPI:1285910703
Name:RUTLEDGE, MEGAN MARIE (MOT, OTR/L)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:MARIE
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:MARIE
Other - Last Name:NOVAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:2403 YORKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-9011
Mailing Address - Country:US
Mailing Address - Phone:810-441-9629
Mailing Address - Fax:586-774-6005
Practice Address - Street 1:2403 YORKSHIRE DR
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-9011
Practice Address - Country:US
Practice Address - Phone:810-441-9629
Practice Address - Fax:586-774-6005
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007649225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist