1114570843 NPI number — MEGAN CLARE KING BARRICKLOW OT

Table of content: MEGAN CLARE KING BARRICKLOW OT (NPI 1114570843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114570843 NPI number — MEGAN CLARE KING BARRICKLOW OT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KING BARRICKLOW
Provider First Name:
MEGAN
Provider Middle Name:
CLARE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KING
Provider Other First Name:
MEGAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114570843
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4325 STATE ROUTE 51 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSTRAVER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-337-6452
Provider Business Mailing Address Fax Number:
724-489-0282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3109 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-241-4020
Provider Business Practice Location Address Fax Number:
304-241-4029
Provider Enumeration Date:
07/22/2019

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:  TOC103585 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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