Healthcare Provider Details

I. General information

NPI: 1326749110
Provider Name (Legal Business Name): MEGAN HUDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 RIVER ST
WINDSOR VT
05089-1445
US

IV. Provider business mailing address

1070 NH ROUTE 4A APT B
ENFIELD NH
03748-3807
US

V. Phone/Fax

Practice location:
  • Phone: 802-291-3236
  • Fax:
Mailing address:
  • Phone: 603-534-7153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number164.0001223
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: