Healthcare Provider Details

I. General information

NPI: 1205293628
Provider Name (Legal Business Name): MEGAN J MAISENBACHER MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN J CALLAHAN MS, LAT, ATC

II. Dates (important events)

Enumeration Date: 01/16/2016
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3773 OLENTANGY RIVER RD
COLUMBUS OH
43214
US

IV. Provider business mailing address

2688 BRISTOL RD
COLUMBUS OH
43221
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-3810
  • Fax: 614-566-3895
Mailing address:
  • Phone: 614-735-4447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT5929
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: