Provider Demographics
NPI:1578369799
Name:REIS, MEGAN JAE (OTR)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:JAE
Last Name:REIS
Suffix:
Gender:
Credentials:OTR
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:JAE
Other - Last Name:HARTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:151 ROCKWOOD PLACE CT
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-1160
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 S KIRKWOOD RD STE 150
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-7251
Practice Address - Country:US
Practice Address - Phone:314-821-7554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO202500452225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist