MEDICARE: VIVIENNE CAROL MEANGER MHS, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	2363	AZ

General Provider Information

NPI Number	:	1154565919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIENNE CAROL MEANGER MHS, OTR/L

Provider Business Mailing Address
First Line	:	7803 E MARQUISE DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85715-3773
Country	:	US
Telephone Number	:	520-977-8924
Fax Number	:	520-721-4948

Provider Business Practice Location Address
First Line	:	7803 E MARQUISE DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85715-3773
Country	:	US
Telephone Number	:	520-977-8924
Fax Number	:	520-721-4948

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2009
Last Update Date	:	06/04/2009

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