Healthcare Provider Details

I. General information

NPI: 1659770378
Provider Name (Legal Business Name): MEGAN MONTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 E MAIN ST SUITE 1
MEDFORD OR
97504-7115
US

IV. Provider business mailing address

836 EAST MAIN ST. SUITE 1
MEDFORD OR
97504
US

V. Phone/Fax

Practice location:
  • Phone: 541-773-9324
  • Fax:
Mailing address:
  • Phone: 541-773-9324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number15804
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: