=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891495347
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN V AUSTIN SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2023
-----------------------------------------------------
Last Update Date | 03/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | SEASIDE REHAB CENTER 850 BAXTER BLVD
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-774-7878
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 PARSONS FARM RD
-----------------------------------------------------
City | BRUNSWICK
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04011-7469
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-729-4970
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SP1304
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------