Provider Demographics
NPI:1376933069
Name:HARDY, MEGAN KATHLEEN (ATC/L)
Entity Type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:KATHLEEN
Last Name:HARDY
Suffix:
Gender:F
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 COBBLERS CIR
Mailing Address - Street 2:
Mailing Address - City:CAROLINA SHORES
Mailing Address - State:NC
Mailing Address - Zip Code:28467-2365
Mailing Address - Country:US
Mailing Address - Phone:423-612-1936
Mailing Address - Fax:
Practice Address - Street 1:550 WHITEVILLE RD NW
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-6556
Practice Address - Country:US
Practice Address - Phone:910-754-4338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1122172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker