Healthcare Provider Details

I. General information

NPI: 1619382066
Provider Name (Legal Business Name): MEAGAN ROSE KRUGGEL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 LAGUNA DR
CARLSBAD CA
92008-1607
US

IV. Provider business mailing address

1108 MCMAHR RD
SAN MARCOS CA
92078-1327
US

V. Phone/Fax

Practice location:
  • Phone: 760-730-9675
  • Fax:
Mailing address:
  • Phone: 925-586-6748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number14151
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number14151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: