Provider Demographics
NPI:1437264397
Name:WINCENT, M. MARGET (OTIII)
Entity Type:Individual
Prefix:MS
First Name:M.
Middle Name:MARGET
Last Name:WINCENT
Suffix:
Gender:F
Credentials:OTIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 LAKEWAY DR
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:TX
Mailing Address - Zip Code:75032-7609
Mailing Address - Country:US
Mailing Address - Phone:214-605-4101
Mailing Address - Fax:
Practice Address - Street 1:310 W KEETOOWAH ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-3824
Practice Address - Country:US
Practice Address - Phone:918-708-9558
Practice Address - Fax:918-708-9580
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5289225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200942830AMedicaid