Healthcare Provider Details

I. General information

NPI: 1548094576
Provider Name (Legal Business Name): MEGAN LYNN SEEMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 N BENTON ST
NEW ATHENS IL
62264-1013
US

IV. Provider business mailing address

208 N BENTON ST
NEW ATHENS IL
62264-1013
US

V. Phone/Fax

Practice location:
  • Phone: 618-792-9732
  • Fax:
Mailing address:
  • Phone: 618-792-9732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: