Healthcare Provider Details

I. General information

NPI: 1063709764
Provider Name (Legal Business Name): MEGHAN HORAN STAPLETON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 4TH AVE SUITE 302A
HUNTINGTON WV
25701-1428
US

IV. Provider business mailing address

1215 FORREST DR
HURRICANE WV
25526-9092
US

V. Phone/Fax

Practice location:
  • Phone: 304-523-1164
  • Fax:
Mailing address:
  • Phone: 518-225-8407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1438
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number010031-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: