MEDICARE: ABBY MEEHAN MS OTR/L

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
1	225X00000X	Occupational Therapist	12862	CA

General Provider Information

NPI Number	:	1376099036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBY MEEHAN MS OTR/L

Provider Business Mailing Address
First Line	:	4035 EAGLE ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-1916
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	541 S V AVE
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-2828
Country	:	US
Telephone Number	:	619-791-7900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	08/31/2016

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