Healthcare Provider Details

I. General information

NPI: 1114299542
Provider Name (Legal Business Name): MEGHAN HUNT MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 MAIN ST
ELLINGTON CT
06029-3339
US

IV. Provider business mailing address

125 SOUTH ST APT 355
VERNON CT
06066-4436
US

V. Phone/Fax

Practice location:
  • Phone: 860-870-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number000748
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: