MEDICARE: MARGARET ODDY CANTWELL RN

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	163W00000X	Registered Nurse	7237633	NY
2	171M00000X	Case Manager/Care Coordinator	7237633	NY

General Provider Information

NPI Number	:	1831452127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET ODDY CANTWELL RN

Provider Business Mailing Address
First Line	:	136 BROADWAY
Second Line	:	SUITE #3
City	:	SARANAC LAKE
State	:	NY
Zip	:	12983-1403
Country	:	US
Telephone Number	:	518-891-4471
Fax Number	:	518-891-7238

Provider Business Practice Location Address
First Line	:	136 BROADWAY
Second Line	:	SUITE #3
City	:	SARANAC LAKE
State	:	NY
Zip	:	12983-1404
Country	:	US
Telephone Number	:	518-891-4471
Fax Number	:	518-891-7238

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

Provider Enumeration Date	:	06/21/2012
Last Update Date	:	06/21/2012

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