Provider Demographics
NPI:1285306522
Name:ROBERSON, MEAGAN KNIGHT (COTA)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:KNIGHT
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:KNIGHT
Other - Last Name:ROBERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1341 PARADISE RD
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-8503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1341 PARADISE RD
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-8503
Practice Address - Country:US
Practice Address - Phone:252-482-7481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6103224Z00000X
NC10195224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty