Provider Demographics
NPI:1831606615
Name:MICOLA, MEGAN (OT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MICOLA
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 1:11 GREAT OAK LN
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CT
Mailing Address - Zip Code:06896-1921
Mailing Address - Country:US
Mailing Address - Phone:203-216-3701
Mailing Address - Fax:203-651-1877
Practice Address - Street 1:6949 MAIN ST
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6304
Practice Address - Country:US
Practice Address - Phone:203-216-3701
Practice Address - Fax:631-651-1877
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001660225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist