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NPI Code Detail

MEDICARE: MEGAN MADDOX DI

MEDICARE: MEGAN MADDOX DI
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
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1902524036
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEGAN MADDOX DI
Provider Business Mailing Address
First Line : 287 HUTCHISON RD
Second Line :
City : PARIS
State : KY
Zip : 40361-9005
Country : US
Telephone Number : 606-584-1169
Fax Number :
Provider Business Practice Location Address
First Line : 287 HUTCHISON RD
Second Line :
City : PARIS
State : KY
Zip : 40361-9005
Country : US
Telephone Number : 606-584-1169
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2022
Last Update Date : 08/15/2022

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