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General NPI Number Information
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NPI Number | 1730215625
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Entity Type | Individual
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Provider Name | MEGHAN MARIE MCGOVERN MS, ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6105 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60659-2313
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Country | US
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Telephone | 773-279-0927
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Fax |
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Provider Business Mailing Address
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Address Line | 1636 DUNDEE DR
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City | WHEATON
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State | IL
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Zip | 60187-7705
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Country | US
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Telephone | 708-805-0230
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 96001533
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License Number State | IL
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