Provider Demographics
NPI:1689317778
Name:HENRY, MARGO THRESA
Entity Type:Individual
Prefix:
First Name:MARGO
Middle Name:THRESA
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 CLOVERTRAIL DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2612
Mailing Address - Country:US
Mailing Address - Phone:314-817-8286
Mailing Address - Fax:
Practice Address - Street 1:1600 N WARSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-1028
Practice Address - Country:US
Practice Address - Phone:314-817-8286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-16
Last Update Date:2022-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health