Provider Demographics
NPI:1366945735
Name:WELCH, MEGAN DENISE (COTA)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:DENISE
Last Name:WELCH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 N RUST AVE
Mailing Address - Street 2:
Mailing Address - City:GENTRY
Mailing Address - State:AR
Mailing Address - Zip Code:72734-9553
Mailing Address - Country:US
Mailing Address - Phone:479-233-1004
Mailing Address - Fax:
Practice Address - Street 1:800 S MOUNT OLIVE ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-4218
Practice Address - Country:US
Practice Address - Phone:918-913-2623
Practice Address - Fax:888-588-4381
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1349224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant