MEDICARE: MEGAN S SEO 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		OR
2	225X00000X	Occupational Therapist	22380	CA

General Provider Information

NPI Number	:	1588303150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN S SEO OTR/L

Provider Business Mailing Address
First Line	:	3129 PROMONTORY WAY
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95135-2230
Country	:	US
Telephone Number	:	408-318-9496
Fax Number	:

Provider Business Practice Location Address
First Line	:	809 FREMONT AVE
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94024-5617
Country	:	US
Telephone Number	:	650-941-5255
Fax Number	:

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

Provider Enumeration Date	:	06/02/2022
Last Update Date	:	06/02/2022

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Directions to “ MEGAN S SEO OTR/L” Practice Location

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