Provider Demographics
NPI:1134331804
Name:DURBIN, MEGAN LEE (ATC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEE
Last Name:DURBIN
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 1:7370 CHADWICK RD
Mailing Address - Street 2:
Mailing Address - City:GAMBIER
Mailing Address - State:OH
Mailing Address - Zip Code:43022-9779
Mailing Address - Country:US
Mailing Address - Phone:740-398-4125
Mailing Address - Fax:
Practice Address - Street 1:289 LAFAYETTE ST
Practice Address - Street 2:SUITES
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-8673
Practice Address - Country:US
Practice Address - Phone:740-845-9025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT 0028342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer