Provider Demographics
NPI:1588331458
Name:SMART, MEGAN L (ATC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:L
Last Name:SMART
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22105 SE SAWYER RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:BLACK DIAMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98010-1315
Mailing Address - Country:US
Mailing Address - Phone:425-466-2168
Mailing Address - Fax:
Practice Address - Street 1:22105 SE SAWYER RIDGE WAY
Practice Address - Street 2:
Practice Address - City:BLACK DIAMOND
Practice Address - State:WA
Practice Address - Zip Code:98010-1315
Practice Address - Country:US
Practice Address - Phone:425-466-2168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA604957232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer