Provider Demographics
NPI:1487980074
Name:HORN, MEGAN C (OTR)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:C
Last Name:HORN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:C
Other - Last Name:THIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:RANDOM LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53075-0323
Mailing Address - Country:US
Mailing Address - Phone:920-994-9700
Mailing Address - Fax:920-994-4606
Practice Address - Street 1:402 FIRST STREET
Practice Address - Street 2:
Practice Address - City:RANDOM LAKE
Practice Address - State:WI
Practice Address - Zip Code:53075
Practice Address - Country:US
Practice Address - Phone:920-994-9700
Practice Address - Fax:920-994-4606
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4291-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000080125Medicare PIN