Healthcare Provider Details

I. General information

NPI: 1083174833
Provider Name (Legal Business Name): MEGAN A HORTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14930 LAPLAISANCE RD STE 118
MONROE MI
48161-3878
US

IV. Provider business mailing address

14930 LAPLAISANCE RD STE 118
MONROE MI
48161-3878
US

V. Phone/Fax

Practice location:
  • Phone: 734-888-6464
  • Fax:
Mailing address:
  • Phone: 734-888-6464
  • Fax: 734-275-0985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201010490
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: