Provider Demographics
NPI:1780185983
Name:KORB, MARGOT (RD)
Entity type:Individual
Prefix:MRS
First Name:MARGOT
Middle Name:
Last Name:KORB
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MARGOT
Other - Middle Name:
Other - Last Name:CICCARELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:5900 BALCONES DR STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4298
Mailing Address - Country:US
Mailing Address - Phone:717-379-6945
Mailing Address - Fax:
Practice Address - Street 1:6365 S 31ST ST APT 703
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3719
Practice Address - Country:US
Practice Address - Phone:717-379-6945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85006133V00000X
PA008879133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered