Provider Demographics
NPI:1528778354
Name:LAVACHE, MARGOT JOSEPH JR
Entity type:Individual
Prefix:
First Name:MARGOT
Middle Name:JOSEPH
Last Name:LAVACHE
Suffix:JR
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 1:5648 EARNINGS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-7430
Mailing Address - Country:US
Mailing Address - Phone:161-449-5701
Mailing Address - Fax:
Practice Address - Street 1:5648 EARNINGS DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-7430
Practice Address - Country:US
Practice Address - Phone:161-449-5701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care