Healthcare Provider Details

I. General information

NPI: 1639666886
Provider Name (Legal Business Name): MARGARET ANN WHEADON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6352 MOHAWK TRCE
GLENFIELD NY
13343-2401
US

IV. Provider business mailing address

157 PRIVATE ROAD ONE
LOWVILLE NY
13367-3118
US

V. Phone/Fax

Practice location:
  • Phone: 315-440-6545
  • Fax:
Mailing address:
  • Phone: 315-376-6915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number015239-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: