Provider Demographics
NPI:1548722911
Name:MICHAEL, MEGEN
Entity type:Individual
Prefix:
First Name:MEGEN
Middle Name:
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 NORTH 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:TREVORTON
Mailing Address - State:PA
Mailing Address - Zip Code:17881
Mailing Address - Country:US
Mailing Address - Phone:570-809-4921
Mailing Address - Fax:
Practice Address - Street 1:500 W LAUREL ST
Practice Address - Street 2:
Practice Address - City:FRACKVILLE
Practice Address - State:PA
Practice Address - Zip Code:17931-2018
Practice Address - Country:US
Practice Address - Phone:570-874-0696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP009575224Z00000X
224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1879251013OtherN/A