Healthcare Provider Details

I. General information

NPI: 1710346770
Provider Name (Legal Business Name): KATIE MEEHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 GREENWOOD ST STE A SUITE B
WORCESTER MA
01607-1767
US

IV. Provider business mailing address

86 FITCH HILL AVE
FITCHBURG MA
01420-3324
US

V. Phone/Fax

Practice location:
  • Phone: 617-285-5186
  • 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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: