Individual
MICHELLE E FANTASKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSC
Contact information
Practice address
1000 COMMERCE PARK DR, STE. 110, WILLIAMSPORT, PA 17701-5475
(570) 323-6944
(570) 323-4529
Mailing address
320 HIGHLAND DR, PO BOX 597, MOUNTVILLE, PA 17554-1232
(717) 285-7121
(717) 285-5302
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BH003229
PA
Other
Enumeration date
12/23/2016
Last updated
12/23/2016
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