Provider Demographics
NPI:1649395617
Name:TENNANT, MARGARET WANDA (OTR L MOT)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:WANDA
Last Name:TENNANT
Suffix:
Gender:F
Credentials:OTR L MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 RIVER RUN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-8313
Mailing Address - Country:US
Mailing Address - Phone:304-363-4566
Mailing Address - Fax:
Practice Address - Street 1:ARBORS AT FAIRMONT
Practice Address - Street 2:130 KAUFMAN DRIVE
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554
Practice Address - Country:US
Practice Address - Phone:304-363-4891
Practice Address - Fax:304-363-4891
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1242225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist