Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | 14151 | CA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 14151 | CA |
NPI | 1619382066 |
---|---|
Provider Name | Mrs. Meagan Rose Kruggel |
First Address | San Marcos, CA 92078-1327 |
Second Address | Carlsbad, CA 92008-1607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2014 |
Last Update Date | 24/06/2014 |