MEDICARE: MEAGANNE CHILDRE OT

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

General Provider Information

NPI Number	:	1679233621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEAGANNE CHILDRE OT

Provider Business Mailing Address
First Line	:	PO BOX 852647
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75085-2647
Country	:	US
Telephone Number	:	972-454-9309
Fax Number	:	972-338-9378

Provider Business Practice Location Address
First Line	:	102 E MAIN ST
Second Line	:
City	:	ROYSE CITY
State	:	TX
Zip	:	75189-3713
Country	:	US
Telephone Number	:	972-454-9309
Fax Number	:	972-338-9378

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

Provider Enumeration Date	:	12/17/2021
Last Update Date	:	12/17/2021

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Directions to “ MEAGANNE CHILDRE OT” Practice Location

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