MEDICARE: MEGAN MARIE CISCO

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	0119009904	VA

General Provider Information

NPI Number	:	1972207694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN MARIE CISCO

Provider Business Mailing Address
First Line	:	128 FAYETTE ST
Second Line	:
City	:	MARTINSVILLE
State	:	VA
Zip	:	24112-2620
Country	:	US
Telephone Number	:	276-352-4465
Fax Number	:	276-293-1212

Provider Business Practice Location Address
First Line	:	209 E CLEVELAND AVE
Second Line	:
City	:	VINTON
State	:	VA
Zip	:	24179-2540
Country	:	US
Telephone Number	:	540-855-8213
Fax Number	:	276-293-1212

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

Provider Enumeration Date	:	03/28/2023
Last Update Date	:	03/28/2023

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Directions to “ MEGAN MARIE CISCO ” Practice Location

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