Provider Demographics
NPI:1891171146
Name:BORN, MEGAN LYNN (MS, ATC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LYNN
Last Name:BORN
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MEADOW LANE DR
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:OH
Mailing Address - Zip Code:43515-9302
Mailing Address - Country:US
Mailing Address - Phone:419-213-0037
Mailing Address - Fax:
Practice Address - Street 1:24 MEADOW LANE DR
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:OH
Practice Address - Zip Code:43515-9302
Practice Address - Country:US
Practice Address - Phone:419-213-0037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-09
Last Update Date:2015-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260020002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer