MEDICARE: MEGAN STREISEL M.ED., LAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	RT005587	PA

General Provider Information

NPI Number	:	1194219170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN STREISEL M.ED., LAT

Provider Business Mailing Address
First Line	:	1144 KOCHENDERFER RD
Second Line	:
City	:	LEBANON
State	:	PA
Zip	:	17046-1909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 N COLLEGE AVE
Second Line	:
City	:	ANNVILLE
State	:	PA
Zip	:	17003-1404
Country	:	US
Telephone Number	:	570-867-6884
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2018
Last Update Date	:	06/21/2018

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