Provider Demographics
NPI:1326711169
Name:WILLISON, MEGAN LOUISE (ATC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LOUISE
Last Name:WILLISON
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 1:112 SILO CT APT 235B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-4975
Mailing Address - Country:US
Mailing Address - Phone:616-915-8690
Mailing Address - Fax:
Practice Address - Street 1:1201 SYRUP MILL RD
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-8493
Practice Address - Country:US
Practice Address - Phone:616-915-8690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAT030762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer