Provider Demographics
NPI:1164825543
Name:BOSWORTH, MEGAN (MA, ATC)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:BOSWORTH
Suffix:
Gender:F
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-1545
Mailing Address - Country:US
Mailing Address - Phone:860-768-5048
Mailing Address - Fax:
Practice Address - Street 1:200 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-1545
Practice Address - Country:US
Practice Address - Phone:860-768-5048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0005972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer