MEDICARE: MEGAN CLASSEN MS, OTR/L, CLT

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	0688	SD
2	225X00000X	Occupational Therapist	1363	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0688	OTHER	SD	LICENSE
2	1363	OTHER	NE	NEBRASKA OT LICENSE

General Provider Information

NPI Number	:	1649446261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN CLASSEN MS, OTR/L, CLT

Provider Business Mailing Address
First Line	:	PO BOX 34669
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68134-0669
Country	:	US
Telephone Number	:	402-932-6791
Fax Number	:	402-614-7835

Provider Business Practice Location Address
First Line	:	2436 N 48TH ST STE 101
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68504-3627
Country	:	US
Telephone Number	:	402-325-6341
Fax Number	:	402-488-0056

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

Provider Enumeration Date	:	05/03/2008
Last Update Date	:	01/05/2022

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