Provider Demographics
NPI:1114148764
Name:KAVANAGH, MEGHAN E (ATC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:E
Last Name:KAVANAGH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 SAVIN AVENUE
Mailing Address - Street 2:APT. 3B
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516
Mailing Address - Country:US
Mailing Address - Phone:203-576-4936
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF BRIDGEPORT
Practice Address - Street 2:120 WALDEMERE AVENUE
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604
Practice Address - Country:US
Practice Address - Phone:203-576-4936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034118152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer