Provider Demographics
NPI:1730490103
Name:LICHTENTHAL, MARGO (OTR)
Entity Type:Individual
Prefix:
First Name:MARGO
Middle Name:
Last Name:LICHTENTHAL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BROOKSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1602
Mailing Address - Country:US
Mailing Address - Phone:732-536-1732
Mailing Address - Fax:
Practice Address - Street 1:31 BROOKSIDE CIRCLE
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1602
Practice Address - Country:US
Practice Address - Phone:732-536-1732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012108-1225X00000X
NJ46TR00020800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist