Provider Demographics
NPI:1720892326
Name:HEAVERN (HARTER), MARGARET
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:HEAVERN (HARTER)
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 1:1201 COLVIN BLVD STE 2A
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1936
Mailing Address - Country:US
Mailing Address - Phone:716-536-9445
Mailing Address - Fax:
Practice Address - Street 1:1201 COLVIN BLVD STE 2A
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223-1936
Practice Address - Country:US
Practice Address - Phone:716-536-9445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist