Provider Demographics
NPI:1649866658
Name:JORDAN, MEGHAN TERESA (COTA)
Entity type:Individual
Prefix:MS
First Name:MEGHAN
Middle Name:TERESA
Last Name:JORDAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:TERESA
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:1151 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-1137
Mailing Address - Country:US
Mailing Address - Phone:401-585-5457
Mailing Address - Fax:
Practice Address - Street 1:11 KING CHARLES DR STE A2
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-1364
Practice Address - Country:US
Practice Address - Phone:401-683-8063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOTA00937224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant