Healthcare Provider Details

I. General information

NPI: 1073656369
Provider Name (Legal Business Name): MEGAN GRINDSTAFF HYMAN M.S., OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14444 BEACH BLVD SUITE 500
JACKSONVILLE FL
32250-2079
US

IV. Provider business mailing address

204 N LAKE CUNNINGHAM AVE
JACKSONVILLE FL
32259-7940
US

V. Phone/Fax

Practice location:
  • Phone: 904-858-7510
  • Fax:
Mailing address:
  • Phone: 904-230-3448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT10152
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: