MEDICARE: MS. MARGARET ANN WHEADON LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	015239-1	NY

General Provider Information

NPI Number	:	1639666886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARGARET ANN WHEADON LMT

Provider Business Mailing Address
First Line	:	157 PRIVATE ROAD ONE
Second Line	:
City	:	LOWVILLE
State	:	NY
Zip	:	13367-3118
Country	:	US
Telephone Number	:	315-376-6915
Fax Number	:

Provider Business Practice Location Address
First Line	:	6352 MOHAWK TRCE
Second Line	:
City	:	GLENFIELD
State	:	NY
Zip	:	13343-2401
Country	:	US
Telephone Number	:	315-440-6545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2018
Last Update Date	:	04/13/2018

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