Provider Demographics
NPI:1124418496
Name:MCMILLEN, MEAGHAN (ATC)
Entity Type:Individual
Prefix:MS
First Name:MEAGHAN
Middle Name:
Last Name:MCMILLEN
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 1:264 COLONNADE DR
Mailing Address - Street 2:APT 27
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4951
Mailing Address - Country:US
Mailing Address - Phone:508-340-7880
Mailing Address - Fax:
Practice Address - Street 1:290 MASSIE RD
Practice Address - Street 2:MCCUE CENTER 1ST FLOOR
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-1767
Practice Address - Country:US
Practice Address - Phone:434-982-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260022332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer