Provider Demographics
NPI:1356039234
Name:JUBON, MEGHAN (OTR/L)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:JUBON
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 1:105 LOVETTE CT
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-3473
Mailing Address - Country:US
Mailing Address - Phone:570-687-7873
Mailing Address - Fax:
Practice Address - Street 1:2070 NORTHBROOK BLVD STE B4
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9254
Practice Address - Country:US
Practice Address - Phone:843-569-3033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6798225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist