Provider Demographics
NPI:1548764210
Name:COLLEY, MEAGAN CATHELENE
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:CATHELENE
Last Name:COLLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 CRAMER CREEK CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-2586
Mailing Address - Country:US
Mailing Address - Phone:614-230-5883
Mailing Address - Fax:
Practice Address - Street 1:299 CRAMER CREEK CT
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2586
Practice Address - Country:US
Practice Address - Phone:614-230-5883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSN636753171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator