Provider Demographics
NPI:1902494206
Name:MINOR, MEGAN COLLEEN (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:COLLEEN
Last Name:MINOR
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7440 DANA LIN CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33917-3326
Mailing Address - Country:US
Mailing Address - Phone:239-826-6505
Mailing Address - Fax:239-230-1585
Practice Address - Street 1:7440 DANA LIN CIR
Practice Address - Street 2:
Practice Address - City:NORTH FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33917-3326
Practice Address - Country:US
Practice Address - Phone:239-826-6505
Practice Address - Fax:239-230-1585
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11318225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT11318OtherOCCUPATIONAL THERAPY LICENSE NUMBER