Provider Demographics
NPI:1629547765
Name:PUMMELL, MEGAN MICHELL (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MICHELL
Last Name:PUMMELL
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-1163
Mailing Address - Country:US
Mailing Address - Phone:734-968-4650
Mailing Address - Fax:
Practice Address - Street 1:19856 SCENIC HARBOUR DR
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1980
Practice Address - Country:US
Practice Address - Phone:734-968-4650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer