Provider Demographics
NPI:1275051856
Name:NOVOM, MEGHAN (OTR/L)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:NOVOM
Suffix:
Gender:
Credentials:OTR/L
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:
Other - Last Name:LEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2720 MARTHA AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-4742
Mailing Address - Country:US
Mailing Address - Phone:805-990-5292
Mailing Address - Fax:
Practice Address - Street 1:121 S MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2311
Practice Address - Country:US
Practice Address - Phone:213-843-5495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA19381225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA19381OtherLICENSED BY CALIFORNIA BOARD OF OCCUPATIONAL THERAPY