Healthcare Provider Details

I. General information

NPI: 1659275345
Provider Name (Legal Business Name): MEGAN PNACEK OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4467 BYRON CENTER AVE SW
WYOMING MI
49519-4808
US

IV. Provider business mailing address

480 BRIAR LN NE
GRAND RAPIDS MI
49503-2172
US

V. Phone/Fax

Practice location:
  • Phone: 616-552-9544
  • Fax:
Mailing address:
  • Phone: 989-615-4320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5201014834
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: