Provider Demographics
NPI:1104475896
Name:THAM, MARGARET
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:THAM
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 1:2201 E ANAHEIM ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3411
Mailing Address - Country:US
Mailing Address - Phone:562-433-2490
Mailing Address - Fax:562-433-0564
Practice Address - Street 1:2201 E ANAHEIM ST STE 200
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3411
Practice Address - Country:US
Practice Address - Phone:562-433-2490
Practice Address - Fax:562-433-0564
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225400000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner