Healthcare Provider Details

I. General information

NPI: 1225701006
Provider Name (Legal Business Name): MEGAN ELIZABETH O'MARA OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 WEALTHY ST SE
GRAND RAPIDS MI
49506-2921
US

IV. Provider business mailing address

1840 WEALTHY ST SE
GRAND RAPIDS MI
49506-2921
US

V. Phone/Fax

Practice location:
  • Phone: 616-382-1299
  • Fax:
Mailing address:
  • Phone: 616-382-1299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: