Healthcare Provider Details

I. General information

NPI: 1043018757
Provider Name (Legal Business Name): MEGAN BERG MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 DEAVER ST
SPRINGDALE AR
72764-5356
US

IV. Provider business mailing address

5184 DEER CREST DR
LITTLE FLOCK AR
72756-7618
US

V. Phone/Fax

Practice location:
  • Phone: 479-259-2339
  • Fax:
Mailing address:
  • Phone: 479-270-0031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR4058
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: