Provider Demographics
NPI:1558480996
Name:HASTINGS, MEG L (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MEG
Middle Name:L
Last Name:HASTINGS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MEG
Other - Middle Name:LIZETTE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1746 PICKWICK PL
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-7286
Mailing Address - Country:US
Mailing Address - Phone:913-634-7972
Mailing Address - Fax:
Practice Address - Street 1:1746 PICKWICK PL
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-7286
Practice Address - Country:US
Practice Address - Phone:913-634-7972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2013-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14615171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor