Provider Demographics
NPI:1033593496
Name:SEBRELL, MEAGAN
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:
Last Name:SEBRELL
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:PO BOX 833
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883
Mailing Address - Country:US
Mailing Address - Phone:419-447-7203
Mailing Address - Fax:419-447-5577
Practice Address - Street 1:2550 S. SR. 100
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883
Practice Address - Country:US
Practice Address - Phone:419-447-7203
Practice Address - Fax:419-447-5577
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0042902255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer