Healthcare Provider Details

I. General information

NPI: 1649042714
Provider Name (Legal Business Name): MEGAN A REUTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5332 WILLIAMS DR
ROSCOE IL
61073-7320
US

IV. Provider business mailing address

2028 S MASTERS ST
BELOIT WI
53511-2724
US

V. Phone/Fax

Practice location:
  • Phone: 815-670-8948
  • Fax:
Mailing address:
  • Phone: 262-903-5473
  • Fax: 262-903-5473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number057.006246
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number7108
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: