Provider Demographics
NPI:1134388630
Name:MACDONALD, MEGAN HELEN (OTR)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:HELEN
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PENNY RD
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6119
Mailing Address - Country:US
Mailing Address - Phone:505-220-8611
Mailing Address - Fax:
Practice Address - Street 1:11 PENNY RD
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6119
Practice Address - Country:US
Practice Address - Phone:505-220-8611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9605171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor