Healthcare Provider Details

I. General information

NPI: 1609758077
Provider Name (Legal Business Name): MEGAN MARIE KOTIL OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3361 PINE RIDGE RD SUITE 105
NAPLES FL
34109-3937
US

IV. Provider business mailing address

3361 PINE RIDGE RD
NAPLES FL
34109-3936
US

V. Phone/Fax

Practice location:
  • Phone: 239-254-4260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT25634
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: