Provider Demographics
NPI:1891343752
Name:DESHAZER, MARGARET TARR (MS, RD/LD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:TARR
Last Name:DESHAZER
Suffix:
Gender:F
Credentials:MS, RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 E BLANCH AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-3633
Mailing Address - Country:US
Mailing Address - Phone:405-822-6129
Mailing Address - Fax:
Practice Address - Street 1:1 S BROADWAY STE 303
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-3706
Practice Address - Country:US
Practice Address - Phone:405-822-6129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK703133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered