Provider Demographics
NPI:1053064196
Name:BLOSSMAN, MARGARET ELLEN
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ELLEN
Last Name:BLOSSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 GALE BREAK CIR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-7214
Mailing Address - Country:US
Mailing Address - Phone:912-257-3770
Mailing Address - Fax:
Practice Address - Street 1:30 GALE BREAK CIR
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-7214
Practice Address - Country:US
Practice Address - Phone:912-257-3770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-29
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty