Provider Demographics
NPI:1093994519
Name:MACLELLAN, MEGHAN (MSECE, CEIS)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:MACLELLAN
Suffix:
Gender:F
Credentials:MSECE, CEIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 COURT ST APT 3C
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-3370
Mailing Address - Country:US
Mailing Address - Phone:508-747-6361
Mailing Address - Fax:
Practice Address - Street 1:64 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4881
Practice Address - Country:US
Practice Address - Phone:508-747-2012
Practice Address - Fax:508-747-4898
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA376442222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist