Provider Demographics
NPI:1174177125
Name:POACH, MEGHAN (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:POACH
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 1:834 E POTTER DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-4161
Mailing Address - Country:US
Mailing Address - Phone:602-663-7117
Mailing Address - Fax:
Practice Address - Street 1:15585 N 91ST AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3543
Practice Address - Country:US
Practice Address - Phone:623-486-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist