Provider Demographics
NPI:1639666886
Name:WHEADON, MARGARET ANN (LMT)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:ANN
Last Name:WHEADON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 PRIVATE ROAD ONE
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-3118
Mailing Address - Country:US
Mailing Address - Phone:315-376-6915
Mailing Address - Fax:
Practice Address - Street 1:6352 MOHAWK TRCE
Practice Address - Street 2:
Practice Address - City:GLENFIELD
Practice Address - State:NY
Practice Address - Zip Code:13343-2401
Practice Address - Country:US
Practice Address - Phone:315-440-6545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015239-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist