Provider Demographics
NPI:1891298493
Name:WOOLUM, MEAGHAN ELIZABETH
Entity Type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:ELIZABETH
Last Name:WOOLUM
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 1:493 GREATHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-7522
Mailing Address - Country:US
Mailing Address - Phone:859-699-6065
Mailing Address - Fax:
Practice Address - Street 1:493 GREATHOUSE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-7522
Practice Address - Country:US
Practice Address - Phone:859-699-6065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-10
Last Update Date:2018-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist