Provider Demographics
NPI:1427676295
Name:MASON, MEGAN (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 BLACKWATCH DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63021-6814
Mailing Address - Country:US
Mailing Address - Phone:314-805-1127
Mailing Address - Fax:
Practice Address - Street 1:4273 KEATON CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8220
Practice Address - Country:US
Practice Address - Phone:636-206-6540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020019918225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics