MEDICARE: MEGHAN HAWTHORNE MS, 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	RT008101	PA

General Provider Information

NPI Number	:	1992687685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGHAN HAWTHORNE MS, LAT, ATC

Provider Business Mailing Address
First Line	:	319 SOUTH MARKET STREET MEMORIAL FIELD HOUSE
Second Line	:
City	:	NEW WILMINGTON
State	:	PA
Zip	:	16172-0001
Country	:	US
Telephone Number	:	724-946-6147
Fax Number	:

Provider Business Practice Location Address
First Line	:	319 SOUTH MARKET STREET MEMORIAL FIELD HOUSE
Second Line	:
City	:	NEW WILMINGTON
State	:	PA
Zip	:	16172-0001
Country	:	US
Telephone Number	:	724-946-6147
Fax Number	:

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

Provider Enumeration Date	:	07/23/2025
Last Update Date	:	07/30/2025

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