Provider Demographics
NPI:1548391857
Name:PUGH, MEAGAN JUDITH (DMIN, ATR-BC, SEP)
Entity Type:Individual
Prefix:MRS
First Name:MEAGAN
Middle Name:JUDITH
Last Name:PUGH
Suffix:
Gender:F
Credentials:DMIN, ATR-BC, SEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 DANIEL ST
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-2704
Mailing Address - Country:US
Mailing Address - Phone:707-823-1131
Mailing Address - Fax:707-824-4877
Practice Address - Street 1:790 DANIEL ST
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-2704
Practice Address - Country:US
Practice Address - Phone:707-823-1131
Practice Address - Fax:707-824-4877
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist