Provider Demographics
NPI:1821525460
Name:SAMSON, MEGAN MARIE (MS, LSLS CERT AVED)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:MARIE
Last Name:SAMSON
Suffix:
Gender:F
Credentials:MS, LSLS CERT AVED
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:MARIE
Other - Last Name:HORNOF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:825 S TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1567
Mailing Address - Country:US
Mailing Address - Phone:314-977-0195
Mailing Address - Fax:314-977-0025
Practice Address - Street 1:825 S TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1567
Practice Address - Country:US
Practice Address - Phone:314-977-0195
Practice Address - Fax:314-977-0025
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-14
Last Update Date:2017-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist