Provider Demographics
NPI:1669541439
Name:DIETZ, MEGAN MICHELE (OT)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:MICHELE
Last Name:DIETZ
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HOME ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15906-3221
Mailing Address - Country:US
Mailing Address - Phone:814-536-5864
Mailing Address - Fax:
Practice Address - Street 1:128 LOGAN BLVD
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-2604
Practice Address - Country:US
Practice Address - Phone:814-317-1081
Practice Address - Fax:814-317-1081
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010211225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist