MEDICARE: MEGAN MARIE JOHNSON 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	4794	CT

General Provider Information

NPI Number	:	1710401427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN MARIE JOHNSON MS, OTR/L

Provider Business Mailing Address
First Line	:	1415 SOUTH ST
Second Line	:
City	:	COVENTRY
State	:	CT
Zip	:	06238-3216
Country	:	US
Telephone Number	:	860-205-5849
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 SOUTH ST
Second Line	:
City	:	COVENTRY
State	:	CT
Zip	:	06238-3216
Country	:	US
Telephone Number	:	860-205-5849
Fax Number	:

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

Provider Enumeration Date	:	08/03/2017
Last Update Date	:	02/11/2023

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