MEDICARE: MRS. MEGAN COLLEEN MINOR MOT, 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	OT11318	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OT11318	OTHER	FL	OCCUPATIONAL THERAPY LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902494206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEGAN COLLEEN MINOR MOT, OTR/L

Provider Business Mailing Address
First Line	:	7440 DANA LIN CIR
Second Line	:
City	:	NORTH FT MYERS
State	:	FL
Zip	:	33917-3326
Country	:	US
Telephone Number	:	239-826-6505
Fax Number	:	239-230-1585

Provider Business Practice Location Address
First Line	:	7440 DANA LIN CIR
Second Line	:
City	:	NORTH FT MYERS
State	:	FL
Zip	:	33917-3326
Country	:	US
Telephone Number	:	239-826-6505
Fax Number	:	239-230-1585

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

Provider Enumeration Date	:	01/04/2021
Last Update Date	:	07/27/2022

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