Provider Demographics
NPI:1083434302
Name:CLANCY, MEGHAN ELISE (OT, OTD, OTR)
Entity type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:ELISE
Last Name:CLANCY
Suffix:
Gender:F
Credentials:OT, OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 MINOT ST APT 3
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-2002
Mailing Address - Country:US
Mailing Address - Phone:774-269-6761
Mailing Address - Fax:
Practice Address - Street 1:17 GREENVILLE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02119-2315
Practice Address - Country:US
Practice Address - Phone:774-269-6761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAOTL15431225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist