Provider Demographics
NPI:1700188562
Name:FERGUSON, MEGGAN MAUREEN (CMT)
Entity Type:Individual
Prefix:MS
First Name:MEGGAN
Middle Name:MAUREEN
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 WHITE CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-9046
Mailing Address - Country:US
Mailing Address - Phone:608-848-9747
Mailing Address - Fax:
Practice Address - Street 1:2817 WHITE CROSSING RD
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-9046
Practice Address - Country:US
Practice Address - Phone:608-848-9747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4976-046225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist