| NPI | 1497144539 |
|---|---|
| Former Name | MEGAN MARIE MCCULLOUGH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MI 2601001074) |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2015-04-01 |