Provider Demographics
NPI:1770945164
Name:NOVAK, MEGAN
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:NOVAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 FOWLER AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-3326
Mailing Address - Country:US
Mailing Address - Phone:570-759-2000
Mailing Address - Fax:570-585-1321
Practice Address - Street 1:3750 ROUTE 220 HWY
Practice Address - Street 2:
Practice Address - City:HUGHESVILLE
Practice Address - State:PA
Practice Address - Zip Code:17737-8367
Practice Address - Country:US
Practice Address - Phone:570-759-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC013408225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist