MEDICARE: MEGAN MCLAUGHLIN

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	096.003414	IL

General Provider Information

NPI Number	:	1972900835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN MCLAUGHLIN

Provider Business Mailing Address
First Line	:	1600 N 1ST AVE APT 1W
Second Line	:
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-2440
Country	:	US
Telephone Number	:	708-256-9131
Fax Number	:

Provider Business Practice Location Address
First Line	:	3127 SUNNYSIDE AVE
Second Line	:
City	:	BROOKFIELD
State	:	IL
Zip	:	60513-1327
Country	:	US
Telephone Number	:	708-256-9131
Fax Number	:

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

Provider Enumeration Date	:	11/20/2014
Last Update Date	:	01/22/2018

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