Provider Demographics
NPI:1033725957
Name:WALTHER, MEGAN MICHELLE
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MICHELLE
Last Name:WALTHER
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 1:2715 COUNTY ROAD 265
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-9419
Mailing Address - Country:US
Mailing Address - Phone:419-559-6870
Mailing Address - Fax:
Practice Address - Street 1:106 N. CATAWBA ROAD
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:46452
Practice Address - Country:US
Practice Address - Phone:419-559-6870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7200942376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0214981Medicaid
OH7200942OtherDODD PROVIDER NUMBER