Provider Demographics
NPI:1962943175
Name:COLEMAN, MEGAN TAYA (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:TAYA
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:TAYA
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD, OTR/L
Mailing Address - Street 1:2175 CAMPBELL PLACE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1331
Mailing Address - Country:US
Mailing Address - Phone:907-529-6039
Mailing Address - Fax:
Practice Address - Street 1:1803 KEPNER DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-3061
Practice Address - Country:US
Practice Address - Phone:907-529-6039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK113929225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist