Provider Demographics
NPI:1235113630
Name:STARR HYLAND, MEGAN LEIGH (PT OPT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEIGH
Last Name:STARR HYLAND
Suffix:
Gender:F
Credentials:PT OPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 VILLAGE PLAZA LOOP
Mailing Address - Street 2:SUITE 145
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6679
Mailing Address - Country:US
Mailing Address - Phone:541-654-0802
Mailing Address - Fax:541-636-4365
Practice Address - Street 1:4730 VILLAGE PLAZA LOOP STE 145
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6679
Practice Address - Country:US
Practice Address - Phone:541-654-0802
Practice Address - Fax:541-636-4365
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4644225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR299051Medicaid
OR299051Medicaid