Provider Demographics
NPI:1124500848
Name:VESEY, MEGAN KIMBERLY (OTR/L)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:KIMBERLY
Last Name:VESEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:WILLOW STREET
Mailing Address - State:PA
Mailing Address - Zip Code:17584-9562
Mailing Address - Country:US
Mailing Address - Phone:717-490-2259
Mailing Address - Fax:
Practice Address - Street 1:6129 PALMETTO ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-5729
Practice Address - Country:US
Practice Address - Phone:215-722-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015751225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist