Provider Demographics
NPI:1780233825
Name:DECANDIA, MEGAN HAYLEY (OTR/L)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:HAYLEY
Last Name:DECANDIA
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 1:330 WALLER AVE STE 275
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2930
Mailing Address - Country:US
Mailing Address - Phone:859-447-8600
Mailing Address - Fax:859-447-8599
Practice Address - Street 1:330 WALLER AVE STE 275
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2930
Practice Address - Country:US
Practice Address - Phone:859-447-8600
Practice Address - Fax:859-447-8599
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY260059225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100633100Medicaid