Provider Demographics
NPI:1538651724
Name:HICKS, MEGAN MARYLENE (MA, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARYLENE
Last Name:HICKS
Suffix:
Gender:F
Credentials:MA, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 HAWTHORN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-4724
Mailing Address - Country:US
Mailing Address - Phone:586-996-3426
Mailing Address - Fax:
Practice Address - Street 1:209 S KINGSHIGHWAY ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-1695
Practice Address - Country:US
Practice Address - Phone:586-996-3426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer