Provider Demographics
NPI:1639775745
Name:GENSIAK, MEGHAN (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:
Last Name:GENSIAK
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MS
Other - First Name:MEGHAN
Other - Middle Name:
Other - Last Name:ANGLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:58 WILLIAMS WAY
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-2531
Mailing Address - Country:US
Mailing Address - Phone:570-335-2263
Mailing Address - Fax:
Practice Address - Street 1:345 N MAIN ST STE 260
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2508
Practice Address - Country:US
Practice Address - Phone:203-816-0091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-05
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC016704225X00000X
CT5890225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist