Provider Demographics
NPI:1700284262
Name:SHIFFLETT, MEGAN RENAE (ATC)
Entity Type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:RENAE
Last Name:SHIFFLETT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:875 PERIMETER DR # MS 2302
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83844-2302
Mailing Address - Country:US
Mailing Address - Phone:208-885-0256
Mailing Address - Fax:208-885-0254
Practice Address - Street 1:875 PERIMETER DR # MS 2302
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83844-2302
Practice Address - Country:US
Practice Address - Phone:208-885-0256
Practice Address - Fax:208-885-0254
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-3482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer