Provider Demographics
NPI:1902204084
Name:SHROLL, MEAGAN LEANN
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:LEANN
Last Name:SHROLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:LEANN
Other - Last Name:WHITCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 S 1ST ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5592
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 CROSS ST
Practice Address - Street 2:
Practice Address - City:BIG STONE CITY
Practice Address - State:SD
Practice Address - Zip Code:57216-8237
Practice Address - Country:US
Practice Address - Phone:605-541-1140
Practice Address - Fax:605-541-0109
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1328225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist