Provider Demographics
NPI:1215757794
Name:LEE, MEGAN SUZANNE (OTD, OTR)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:SUZANNE
Last Name:LEE
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 TREASURE CV
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-4479
Mailing Address - Country:US
Mailing Address - Phone:281-713-0848
Mailing Address - Fax:
Practice Address - Street 1:3420 NE EVANGELINE TRWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-2554
Practice Address - Country:US
Practice Address - Phone:337-534-8978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA344527225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist