Provider Demographics
NPI:1932271392
Name:WELLS, MEGAN (OT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:WELLS
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 1:4411 KINSEY DR
Mailing Address - Street 2:APT 825
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1002
Mailing Address - Country:US
Mailing Address - Phone:903-534-9307
Mailing Address - Fax:903-561-2868
Practice Address - Street 1:102 E GRAND PLZ
Practice Address - Street 2:
Practice Address - City:GRAND SALINE
Practice Address - State:TX
Practice Address - Zip Code:75140-1932
Practice Address - Country:US
Practice Address - Phone:903-962-7901
Practice Address - Fax:903-962-3082
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111791225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist