Provider Demographics
NPI:1366401655
Name:WILLIAMS, MARGO JEAN (CO, LO, CLT-LANA)
Entity type:Individual
Prefix:
First Name:MARGO
Middle Name:JEAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CO, LO, CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 112056
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75011-2056
Mailing Address - Country:US
Mailing Address - Phone:469-371-2686
Mailing Address - Fax:972-242-4253
Practice Address - Street 1:1199 S BELT LINE RD
Practice Address - Street 2:SUITE 140
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4666
Practice Address - Country:US
Practice Address - Phone:469-371-2686
Practice Address - Fax:972-242-4253
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX158222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5285350001Medicare NSC