MEDICARE: MEGAN MCCORMACK

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	:	1689976839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN MCCORMACK

Provider Business Mailing Address
First Line	:	314 79TH ST
Second Line	:	#5E
City	:	BROOKLYN
State	:	NY
Zip	:	11209-3646
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 79TH ST
Second Line	:	#5E
City	:	BROOKLYN
State	:	NY
Zip	:	11209-3646
Country	:	US
Telephone Number	:	718-419-1225
Fax Number	:

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

Provider Enumeration Date	:	11/20/2010
Last Update Date	:	11/20/2010

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