Provider Demographics
NPI:1275198855
Name:WIDIKER, MEGAN KATHERINE
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:KATHERINE
Last Name:WIDIKER
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 1:509 W POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:WI
Mailing Address - Zip Code:54822-7502
Mailing Address - Country:US
Mailing Address - Phone:715-790-3985
Mailing Address - Fax:
Practice Address - Street 1:2225 EAGLE SMT
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54482-8977
Practice Address - Country:US
Practice Address - Phone:715-544-6506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant