Provider Demographics
NPI:1376797969
Name:FARON, MARGO E (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARGO
Middle Name:E
Last Name:FARON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 NW 10TH WAY
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4260
Mailing Address - Country:US
Mailing Address - Phone:607-765-4696
Mailing Address - Fax:
Practice Address - Street 1:11104 NE 149TH ST
Practice Address - Street 2:
Practice Address - City:BRUSH PRAIRIE
Practice Address - State:WA
Practice Address - Zip Code:98606-9565
Practice Address - Country:US
Practice Address - Phone:360-885-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-09
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010382-1225X00000X
WAOT 60575891225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist