Healthcare Provider Details

I. General information

NPI: 1144296260
Provider Name (Legal Business Name): MARGARET ANN BLACKMORE-HAUS ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7790 COLLEGE STATION DR
WILLIAMSBURG KY
40769-1388
US

IV. Provider business mailing address

210 S 9TH ST
WILLIAMSBURG KY
40769-1321
US

V. Phone/Fax

Practice location:
  • Phone: 606-539-4131
  • Fax: 606-539-4126
Mailing address:
  • Phone: 606-549-0929
  • Fax: 606-539-4126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: