Healthcare Provider Details

I. General information

NPI: 1710241393
Provider Name (Legal Business Name): MEGAN MARIE LIMA ATC, OTC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN MARIE PROBASCO ATC, OTC

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 DUFF AVE
AMES IA
50010
US

IV. Provider business mailing address

1401 NW 27TH ST.
ANKENY IA
50323
US

V. Phone/Fax

Practice location:
  • Phone: 515-239-4475
  • Fax: 515-239-4722
Mailing address:
  • Phone: 515-681-2014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number000989
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: