Provider Demographics
NPI:1902438609
Name:MORMILE, MEGAN ELIZABETH EVELYN (ATC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELIZABETH EVELYN
Last Name:MORMILE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TRUMANSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14886-8906
Mailing Address - Country:US
Mailing Address - Phone:607-351-8222
Mailing Address - Fax:
Practice Address - Street 1:16 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TRUMANSBURG
Practice Address - State:NY
Practice Address - Zip Code:14886-8906
Practice Address - Country:US
Practice Address - Phone:607-351-8222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL57622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer