Provider Demographics
NPI:1699128850
Name:DEHAVEN, MEGAN (MS, LAT, ATC)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:DEHAVEN
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:PLUMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2140 N HAYDEN DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4352
Mailing Address - Country:US
Mailing Address - Phone:619-200-3350
Mailing Address - Fax:
Practice Address - Street 1:501 FAIRMOUNT AVE STE 302
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5494
Practice Address - Country:US
Practice Address - Phone:410-324-7543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT63042255A2300X
AZATR-0091732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer