Healthcare Provider Details

I. General information

NPI: 1134463433
Provider Name (Legal Business Name): MARGARET L SOUTHARD SP ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5962 RT 31 SUITE 7 BOX 10
CICERO NY
13039
US

IV. Provider business mailing address

171 INTREPID LN
SYRACUSE NY
13205-2548
US

V. Phone/Fax

Practice location:
  • Phone: 315-698-0033
  • Fax: 315-698-0031
Mailing address:
  • Phone: 315-437-4698
  • Fax: 315-437-4689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: