Provider Demographics
NPI:1245204262
Name:BERRY, MEGHAN MAREA (ATC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:MAREA
Last Name:BERRY
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 1:3194 RIVERVIEW DR NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-8544
Mailing Address - Country:US
Mailing Address - Phone:515-451-9012
Mailing Address - Fax:
Practice Address - Street 1:GRAND VALLEY STATE UNIVERSITY
Practice Address - Street 2:1 CAMPUS DR
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401
Practice Address - Country:US
Practice Address - Phone:616-331-2859
Practice Address - Fax:616-331-3232
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist