Basic Information
| Provider Information | |||||||||
| NPI: | 1548337058 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUCICH | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | MCCACHREN | ||||||||
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| Credential: | MOTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3305 S ORANGE AVE | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328066125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078523310 | ||||||||
| FaxNumber: | 4078523301 | ||||||||
| Practice Location | |||||||||
| Address1: | 3590 NORTH HIGHWAY 17-92 | ||||||||
| Address2: | SUITE 1038 | ||||||||
| City: | LAKE MARY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327463866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073226222 | ||||||||
| FaxNumber: | 4073225596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2006 | ||||||||
| LastUpdateDate: | 01/21/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT10322 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 887491300 | 05 | FL | MEDICAID |