Healthcare Provider Details

I. General information

NPI: 1174176960
Provider Name (Legal Business Name): MEGAN A COLGLAZIER BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2019
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 FREEMAN RIDGE RD
NASHVILLE IN
47448-8483
US

IV. Provider business mailing address

760 FREEMAN RIDGE RD
NASHVILLE IN
47448-8483
US

V. Phone/Fax

Practice location:
  • Phone: 812-447-2743
  • Fax:
Mailing address:
  • Phone:
  • 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: