Healthcare Provider Details

I. General information

NPI: 1912442955
Provider Name (Legal Business Name): MEGAN HOLLOWAY RAYMOND MOT, LOTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2016
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6218 CRESTING KNOLLS CIR
RICHMOND TX
77407-1613
US

IV. Provider business mailing address

PO BOX 1661
SUGAR LAND TX
77487-1661
US

V. Phone/Fax

Practice location:
  • Phone: 318-518-4162
  • Fax:
Mailing address:
  • Phone: 318-518-4162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number300617
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number123380
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: