Provider Demographics
NPI:1316498496
Name:PAUGH, MEGAN LEIGH (LMBT, NMT #14865)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEIGH
Last Name:PAUGH
Suffix:
Gender:F
Credentials:LMBT, NMT #14865
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 MOUNT PLEASANT RD S
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-8423
Mailing Address - Country:US
Mailing Address - Phone:704-467-6336
Mailing Address - Fax:
Practice Address - Street 1:6000 MOUNT PLEASANT RD S
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-8423
Practice Address - Country:US
Practice Address - Phone:704-467-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14865225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC949944745SMedicaid