Provider Demographics
NPI:1205469897
Name:GROAT, MEGAN (CTRS)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:GROAT
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-5716
Mailing Address - Country:US
Mailing Address - Phone:248-760-2923
Mailing Address - Fax:
Practice Address - Street 1:914 LAKE DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-5716
Practice Address - Country:US
Practice Address - Phone:248-760-2923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI82555225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist