Provider Demographics
NPI:1902252158
Name:SIEFKAS, MEGAN (COTA/L)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:SIEFKAS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 ROOSEVELT ST
Mailing Address - Street 2:APT # D6
Mailing Address - City:SABETHA
Mailing Address - State:KS
Mailing Address - Zip Code:66534-1648
Mailing Address - Country:US
Mailing Address - Phone:816-499-2155
Mailing Address - Fax:
Practice Address - Street 1:25117 SW PARKWAY AVE
Practice Address - Street 2:STE D
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9697
Practice Address - Country:US
Practice Address - Phone:971-224-2040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-01230224Z00000X
NE987224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant