Healthcare Provider Details
I. General information
NPI: 1255321618
Provider Name (Legal Business Name): MEGAN BRISTOW OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 10/26/2005
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
16528 E DESMET CT STE B2200
SPOKANE VALLEY WA
99216-3522
US
IV. Provider business mailing address
PO BOX 421
LIBERTY LAKE WA
99019-0421
US
V. Phone/Fax
- Phone: 509-944-8920
- Fax: 509-227-7070
- Phone: 866-747-2455
- Fax: 509-944-9644
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225X00000X |
| Taxonomy | Occupational Therapist |
| License Number | OT00003865 |
| License Number State | WA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225XE1200X |
| Taxonomy | Ergonomics Occupational Therapist |
| License Number | OT00003865 |
| License Number State | WA |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 225XH1200X |
| Taxonomy | Hand Occupational Therapist |
| License Number | OT00003865 |
| License Number State | WA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: