MEDICARE: MEGAN PODSIADLIK 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
1	225X00000X	Occupational Therapist	5201011354	MI

General Provider Information

NPI Number	:	1518638220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN PODSIADLIK OTRL

Provider Business Mailing Address
First Line	:	1980 GRIM RD
Second Line	:
City	:	BENTLEY
State	:	MI
Zip	:	48613-9634
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 HARRIS AVE
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-9680
Country	:	US
Telephone Number	:	989-362-4424
Fax Number	:

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

Provider Enumeration Date	:	09/22/2021
Last Update Date	:	09/24/2021

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