1639783681 NPI number — MEGHAN VERONICA HAMPTON LAT, MA, ATC

Table of content: MEGHAN VERONICA HAMPTON LAT, MA, ATC (NPI 1639783681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639783681 NPI number — MEGHAN VERONICA HAMPTON LAT, MA, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMPTON
Provider First Name:
MEGHAN
Provider Middle Name:
VERONICA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LAT, MA, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MALINOWSKI
Provider Other First Name:
MEGHAN
Provider Other Middle Name:
VERONICA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, ATC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639783681
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9151 CEDAR LAKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINCKNEY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48169-8893
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-718-5082
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13245 NEWBURGH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVONIA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48150-5011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-655-8240
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2020

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: 2255A2300X , with the licence number:  2601002010 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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