Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 0119006787 | VA |
NPI | 1003314493 |
---|---|
Provider Name | Mrs. Megan Elise Evelyn Breakall |
First Address | North Chesterfield, VA 23235-5651 |
Second Address | Richmond, VA 23227-4328 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2018 |
Last Update Date | 31/01/2018 |