Provider Demographics
NPI:1255804068
Name:MEZERA, MEGAN E (LAT, ATC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:E
Last Name:MEZERA
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:LECLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:429 E CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:WI
Mailing Address - Zip Code:53813-1716
Mailing Address - Country:US
Mailing Address - Phone:920-493-5632
Mailing Address - Fax:
Practice Address - Street 1:105 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:WI
Practice Address - Zip Code:53813-2019
Practice Address - Country:US
Practice Address - Phone:608-723-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2349-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer