Provider Demographics
NPI:1285238105
Name:MCCUISTON, MEGAN RAE (COTA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:RAE
Last Name:MCCUISTON
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 1:8778 FISHER DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-6256
Mailing Address - Country:US
Mailing Address - Phone:270-339-6373
Mailing Address - Fax:
Practice Address - Street 1:8778 FISHER DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-6256
Practice Address - Country:US
Practice Address - Phone:270-339-6373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215591224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant