Healthcare Provider Details

I. General information

NPI: 1689152258
Provider Name (Legal Business Name): MEGAN LAUREL BATUSIC LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2018
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 E YOUNG AVE STE E
WARRENSBURG MO
64093-1250
US

IV. Provider business mailing address

6397 LEE HWY STE 300
CHATTANOOGA TN
37421-4915
US

V. Phone/Fax

Practice location:
  • Phone: 660-262-4795
  • Fax: 660-747-0347
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2016026030
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: