Provider Demographics
NPI:1063012243
Name:HARTY, MEGAN ALICIA
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ALICIA
Last Name:HARTY
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 1:183 I ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-4049
Mailing Address - Country:US
Mailing Address - Phone:978-998-5803
Mailing Address - Fax:
Practice Address - Street 1:183 I ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-4049
Practice Address - Country:US
Practice Address - Phone:978-998-5803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist