Provider Demographics
NPI:1154630036
Name:DODGE, MEGAN D (ATC, DPT)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:D
Last Name:DODGE
Suffix:
Gender:F
Credentials:ATC, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-626-6161
Mailing Address - Fax:419-502-3511
Practice Address - Street 1:164 MILAN AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-1146
Practice Address - Country:US
Practice Address - Phone:419-660-0876
Practice Address - Fax:419-660-9104
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.002987174400000X
OHPT.012923174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH505721Medicaid