MEDICARE: MEGAN MARYLENE HICKS MA, LAT, 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	:	1538651724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN MARYLENE HICKS MA, LAT, ATC

Provider Business Mailing Address
First Line	:	922 HAWTHORN AVE
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-4724
Country	:	US
Telephone Number	:	586-996-3426
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 S KINGSHIGHWAY ST
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-1695
Country	:	US
Telephone Number	:	586-996-3426
Fax Number	:

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

Provider Enumeration Date	:	06/04/2018
Last Update Date	:	07/24/2023

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