Provider Demographics
NPI:1619434404
Name:HALL, MEAGAN DUKE
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:DUKE
Last Name:HALL
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 1:9293 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7921
Mailing Address - Country:US
Mailing Address - Phone:850-588-9641
Mailing Address - Fax:888-711-0441
Practice Address - Street 1:9293 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-7921
Practice Address - Country:US
Practice Address - Phone:850-588-9641
Practice Address - Fax:888-711-0441
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6189225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist