Healthcare Provider Details

I. General information

NPI: 1942558358
Provider Name (Legal Business Name): MEGHAN ANNE ROSE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 08/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2153 CORAL WAY SUITE 602
CORAL GABLES FL
33145-2631
US

IV. Provider business mailing address

500 N. BULLARD AVE C27
GOODYEAR AZ
85338
US

V. Phone/Fax

Practice location:
  • Phone: 305-856-1999
  • Fax: 305-856-7600
Mailing address:
  • Phone: 623-986-5110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC012394
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT16436
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6221
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: