Healthcare Provider Details

I. General information

NPI: 1730727330
Provider Name (Legal Business Name): MEGAN CANTRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6441 SOUTH HWY
SALT LICK KY
40371
US

IV. Provider business mailing address

436 HOUSTON OAKS DR
PARIS KY
40361-2704
US

V. Phone/Fax

Practice location:
  • Phone: 859-585-0479
  • Fax:
Mailing address:
  • Phone: 606-584-1169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: