1669668778 NPI number — MRS. MEGAN CHRISTY COPELAND OTR

Table of content: MRS. MEGAN CHRISTY COPELAND OTR (NPI 1669668778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669668778 NPI number — MRS. MEGAN CHRISTY COPELAND OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COPELAND
Provider First Name:
MEGAN
Provider Middle Name:
CHRISTY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHRISTY
Provider Other First Name:
MEGAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1669668778
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4510 27TH ST
Provider Second Line Business Mailing Address:
BENDER TERRACE
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79410-1709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-785-2464
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4510 27TH ST
Provider Second Line Business Practice Location Address:
BENDER TERRACE
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79410-1709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-785-2464
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  112266 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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