Healthcare Provider Details

I. General information

NPI: 1457798969
Provider Name (Legal Business Name): MEGAN SLIVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 E LANSING DR
EAST LANSING MI
48823-7754
US

IV. Provider business mailing address

2700 E LANSING DR
EAST LANSING MI
48823-7754
US

V. Phone/Fax

Practice location:
  • Phone: 517-332-1616
  • Fax:
Mailing address:
  • Phone: 517-332-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: