Provider Demographics
NPI:1811433840
Name:FOWLER, MEGAN (LMT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:ERWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:344 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1742
Mailing Address - Country:US
Mailing Address - Phone:518-651-4166
Mailing Address - Fax:
Practice Address - Street 1:344 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1742
Practice Address - Country:US
Practice Address - Phone:518-651-4166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-14
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024080225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist