=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962895359
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGHAN FURNER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2015
-----------------------------------------------------
Last Update Date | 03/15/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5647 E MAIN ST
-----------------------------------------------------
City | VERONA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13478-3534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-363-2580
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4937 SPRING RD
-----------------------------------------------------
City | VERONA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13478-3526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235500000X
-----------------------------------------------------
Taxonomy Name | Speech/Language/Hearing Specialist/Technologist
-----------------------------------------------------
License Number | 1199494
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------