Healthcare Provider Details

I. General information

NPI: 1578369799
Provider Name (Legal Business Name): MEGAN JAE REIS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN JAE HARTY

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S KIRKWOOD RD STE 150
SAINT LOUIS MO
63122-7251
US

IV. Provider business mailing address

151 ROCKWOOD PLACE CT
EUREKA MO
63025-1160
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-7554
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number202500452
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: