Healthcare Provider Details

I. General information

NPI: 1790282580
Provider Name (Legal Business Name): MEGHAN ELIZABETH THOMAS ATC, CFO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 LINCOLN ST
SPRINGFIELD VT
05156
US

IV. Provider business mailing address

310 TAUGHANNOCK BLVD STE 5
ITHACA NY
14850-3251
US

V. Phone/Fax

Practice location:
  • Phone: 802-275-8484
  • Fax:
Mailing address:
  • Phone: 607-252-3580
  • Fax: 607-252-3971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberCFO05421
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1325
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number004592
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: