Provider Demographics
NPI:1205293628
Name:MAISENBACHER, MEGAN J (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:J
Last Name:MAISENBACHER
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:J
Other - Last Name:CALLAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LAT, ATC
Mailing Address - Street 1:2688 BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221
Mailing Address - Country:US
Mailing Address - Phone:614-735-4447
Mailing Address - Fax:
Practice Address - Street 1:3773 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214
Practice Address - Country:US
Practice Address - Phone:614-566-3810
Practice Address - Fax:614-566-3895
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-16
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT59292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer