Provider Demographics
NPI:1174289334
Name:DEWAELE, MEGHAN JOSEPHINE
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:JOSEPHINE
Last Name:DEWAELE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 WILDER RD STE D
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2482
Mailing Address - Country:US
Mailing Address - Phone:894-021-2159
Mailing Address - Fax:
Practice Address - Street 1:3720 WILDER RD STE D
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2482
Practice Address - Country:US
Practice Address - Phone:894-021-2159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22519225X00000X
MI5201013866225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist