Provider Demographics
NPI:1194290205
Name:MEGBULUBA, ROWENA (COTA)
Entity type:Individual
Prefix:
First Name:ROWENA
Middle Name:
Last Name:MEGBULUBA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 BUNKER HILL LN TRLR 91
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-9506
Mailing Address - Country:US
Mailing Address - Phone:469-237-4899
Mailing Address - Fax:
Practice Address - Street 1:4400 WALNUT ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-5586
Practice Address - Country:US
Practice Address - Phone:888-531-2204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215281224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant