Provider Demographics
NPI:1528322187
Name:FORSTER, MEGEN
Entity type:Individual
Prefix:
First Name:MEGEN
Middle Name:
Last Name:FORSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEGEN
Other - Middle Name:
Other - Last Name:GALBRAITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5832 N LAPEER RD
Practice Address - Street 2:STE A
Practice Address - City:NORTH BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48461-8144
Practice Address - Country:US
Practice Address - Phone:810-793-5282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201001931225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist