Provider Demographics
NPI:1568657831
Name:O'MALLEY, MEAGAN (MS,OTR/L)
Entity type:Individual
Prefix:MISS
First Name:MEAGAN
Middle Name:
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ROCK ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-2309
Mailing Address - Country:US
Mailing Address - Phone:774-266-0095
Mailing Address - Fax:
Practice Address - Street 1:15 ROCK ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-2309
Practice Address - Country:US
Practice Address - Phone:774-266-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9532225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist