=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821413139
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN CARROLL M.S.ED
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2014
-----------------------------------------------------
Last Update Date | 02/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 43 E MAIN ST UPPER
-----------------------------------------------------
City | SPRINGVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14141-1224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-794-3535
-----------------------------------------------------
Fax | 716-794-3536
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 322 ROBERT DR APT 6
-----------------------------------------------------
City | NORTH TONAWANDA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14120-5647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-609-9977
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 725039131
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------