Healthcare Provider Details

I. General information

NPI: 1386558625
Provider Name (Legal Business Name): MARGARET ANN FATHI NDT,R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14611 SOUTHERN BLVD UNIT 1098
LOXAHATCHEE FL
33470-6848
US

IV. Provider business mailing address

305 WAVERLY CIR
DAYTONA BEACH FL
32118-3619
US

V. Phone/Fax

Practice location:
  • Phone: 614-985-6567
  • Fax:
Mailing address:
  • Phone: 386-299-3626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: