Healthcare Provider Details

I. General information

NPI: 1275116097
Provider Name (Legal Business Name): MEGAN GUMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16505 VIRGINIA AVE
WILLIAMSPORT MD
21795-1321
US

IV. Provider business mailing address

16505 VIRGINIA AVE
WILLIAMSPORT MD
21795-1321
US

V. Phone/Fax

Practice location:
  • Phone: 301-223-5221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberA02883
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: