Provider Demographics
NPI:1841942943
Name:RADLE, MEGAN ELIZABETH (CPT, CES, NC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:RADLE
Suffix:
Gender:F
Credentials:CPT, CES, NC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ELIZABETH
Other - Last Name:KEGLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPT, CES, NC
Mailing Address - Street 1:120 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-5325
Mailing Address - Country:US
Mailing Address - Phone:715-514-0424
Mailing Address - Fax:
Practice Address - Street 1:120 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-5325
Practice Address - Country:US
Practice Address - Phone:715-514-0424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI