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General NPI Number Information
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NPI Number | 1124849799
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Entity Type | Individual
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Provider Name | MEGAN LEE WALLIS OTD, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 1000 EXECUTIVE PARKWAY DR STE 120
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6369
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Country | US
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Telephone | 314-828-1443
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Fax |
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Provider Business Mailing Address
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Address Line | 7901 CORNELL AVE
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City | UNIVERSITY CITY
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State | MO
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Zip | 63130-3704
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Country | US
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Telephone | 636-368-5972
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 2024039348
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License Number State | MO
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