MEDICARE: MEGAN LYNN PRIDDY ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1366546061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN LYNN PRIDDY ATC

Provider Business Mailing Address
First Line	:	1437 TIPPECANOE ST
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47807-2246
Country	:	US
Telephone Number	:	201-887-0492
Fax Number	:

Provider Business Practice Location Address
First Line	:	4TH AND CHESTNUT ST
Second Line	:	INDIANA STATE UNIVERSITY
City	:	TERRE HAUTE
State	:	IN
Zip	:	47809-0001
Country	:	US
Telephone Number	:	812-237-9613
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	07/08/2007

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