Provider Demographics
NPI:1972030369
Name:TRELLA, MEGHAN ELISABETH (ATC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:ELISABETH
Last Name:TRELLA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 PINE TREE PATH APT 1
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8786
Mailing Address - Country:US
Mailing Address - Phone:229-237-2950
Mailing Address - Fax:
Practice Address - Street 1:400 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-1628
Practice Address - Country:US
Practice Address - Phone:229-237-2950
Practice Address - Fax:229-237-2950
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT11802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer