Provider Demographics
NPI:1659600898
Name:CARRICK, MEGAN M (OTR/L)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:CARRICK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 NORTHFIELD RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3374
Mailing Address - Country:US
Mailing Address - Phone:847-784-9115
Mailing Address - Fax:
Practice Address - Street 1:222 NORTHFIELD RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3374
Practice Address - Country:US
Practice Address - Phone:847-784-9115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-007384174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist