Healthcare Provider Details

I. General information

NPI: 1508202573
Provider Name (Legal Business Name): MEGAN RENAE WITTE BEWERNITZ OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN RENAE WITTE OTR/L

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20400 SARATOGA LOS GATOS RD
SARATOGA CA
95070-5927
US

IV. Provider business mailing address

20400 SARATOGA LOS GATOS RD
SARATOGA CA
95070-5927
US

V. Phone/Fax

Practice location:
  • Phone: 408-741-4930
  • Fax: 408-741-4930
Mailing address:
  • Phone: 408-741-4930
  • Fax: 408-741-4930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number13342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: