Provider Demographics
NPI:1659770378
Name:MONTE, MEGAN
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MONTE
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 1:836 EAST MAIN ST.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504
Mailing Address - Country:US
Mailing Address - Phone:541-773-9324
Mailing Address - Fax:
Practice Address - Street 1:836 E MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7115
Practice Address - Country:US
Practice Address - Phone:541-773-9324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15804225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist