Healthcare Provider Details

I. General information

NPI: 1487881769
Provider Name (Legal Business Name): MEGHAN MCDERMOTT BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 06/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 COLE ST APARTMENT 2
EAST PROVIDENCE RI
02914-2601
US

IV. Provider business mailing address

29 COLE ST APARTMENT 2
EAST PROVIDENCE RI
02914-2601
US

V. Phone/Fax

Practice location:
  • Phone: 401-575-8868
  • Fax: 508-679-8590
Mailing address:
  • Phone: 401-575-8868
  • Fax: 508-679-8590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: