Provider Demographics
NPI:1447809868
Name:BOSTIC, MEGHAN LEIGH (COTA)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:LEIGH
Last Name:BOSTIC
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 1:310 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:75840-2518
Mailing Address - Country:US
Mailing Address - Phone:903-390-1864
Mailing Address - Fax:
Practice Address - Street 1:420 MOODY ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:TX
Practice Address - Zip Code:75840-3036
Practice Address - Country:US
Practice Address - Phone:903-389-1236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215850224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant