Provider Demographics
NPI:1033500061
Name:PHIPPS, MEGAN
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 NORTH SANDERS AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHILHOWIE
Mailing Address - State:VA
Mailing Address - Zip Code:24319
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:104 NORTH SANDERS AVENUE
Practice Address - Street 2:
Practice Address - City:CHILHOWIE
Practice Address - State:VA
Practice Address - Zip Code:24319
Practice Address - Country:US
Practice Address - Phone:276-646-8774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004867225X00000X
TN3985225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist