MEDICARE: MEGAN ELIZABETH SHORT 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	224Z00000X	Occupational Therapy Assistant	04589	OH
2	225X00000X	Occupational Therapist	OT011787	OH

General Provider Information

NPI Number	:	1962774604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN ELIZABETH SHORT OTR/L

Provider Business Mailing Address
First Line	:	36159 COUNTY ROAD 70
Second Line	:
City	:	WARSAW
State	:	OH
Zip	:	43844-9789
Country	:	US
Telephone Number	:	740-575-2542
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 E MAIN ST
Second Line	:
City	:	WEST LAFAYETTE
State	:	OH
Zip	:	43845-1267
Country	:	US
Telephone Number	:	740-545-6355
Fax Number	:

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

Provider Enumeration Date	:	01/26/2012
Last Update Date	:	01/18/2022

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