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NPI Code Detail

MEDICARE: MEAGAN FRANCES BERGQUIST OTRL

MEDICARE:   MEAGAN FRANCES BERGQUIST  OTRL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist5201010330MI

General Provider Information

NPI Number : 1336614932
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEAGAN FRANCES BERGQUIST OTRL
Provider Business Mailing Address
First Line : 820 MONROE AVE NW APT 207
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-1418
Country : US
Telephone Number : 616-901-1435
Fax Number :
Provider Business Practice Location Address
First Line : 695 MITZI ST
Second Line :
City : NORTH MUSKEGON
State : MI
Zip : 49445-3232
Country : US
Telephone Number : 231-744-1641
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2018
Last Update Date : 10/10/2018

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Directions to “ MEAGAN FRANCES BERGQUIST OTRL” Practice Location

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