Provider Demographics
NPI:1184818312
Name:EICHHOLZ, MARGO LEANN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MARGO
Middle Name:LEANN
Last Name:EICHHOLZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 H AVE
Mailing Address - Street 2:
Mailing Address - City:GRUNDY CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50638
Mailing Address - Country:US
Mailing Address - Phone:319-825-5597
Mailing Address - Fax:
Practice Address - Street 1:102 E. J. AVE
Practice Address - Street 2:
Practice Address - City:GRUNDY CENTER
Practice Address - State:IA
Practice Address - Zip Code:50638
Practice Address - Country:US
Practice Address - Phone:319-824-5436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00614174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist