MEDICARE: MEGAN MCCACHREN SUCICH MOTR/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	OT10322	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548337058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN MCCACHREN SUCICH MOTR/L

Provider Business Mailing Address
First Line	:	3305 S ORANGE AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806-6125
Country	:	US
Telephone Number	:	407-852-3310
Fax Number	:	407-852-3301

Provider Business Practice Location Address
First Line	:	3590 NORTH HIGHWAY 17-92
Second Line	:	SUITE 1038
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3866
Country	:	US
Telephone Number	:	407-322-6222
Fax Number	:	407-322-5596

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	01/21/2011

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