Provider Demographics
NPI:1871964932
Name:RODENBERG, MEAGAN (OTR/L)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:
Last Name:RODENBERG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2824
Mailing Address - Country:US
Mailing Address - Phone:636-821-9815
Mailing Address - Fax:
Practice Address - Street 1:317 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2824
Practice Address - Country:US
Practice Address - Phone:636-821-9815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO2015024382225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist