Healthcare Provider Details

I. General information

NPI: 1063342269
Provider Name (Legal Business Name): MEGAN DORAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

204 W 4TH ST
WASHINGTON MO
63090-2316
US

IV. Provider business mailing address

204 W 4TH ST
WASHINGTON MO
63090-2316
US

V. Phone/Fax

Practice location:
  • Phone: 636-283-0211
  • Fax: 636-249-1155
Mailing address:
  • Phone: 636-283-0211
  • Fax: 636-249-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2025043172
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: