Individual
DEBORAH C FANARA-VIASUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
55 DIMOCK ST, ROXBURY, MA 02119-1029
(617) 442-8800
Mailing address
196 WATERTOWN ST, WATERTOWN, MA 02472-2574
(617) 923-3086
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
6742
MA
Other
Enumeration date
12/11/2006
Last updated
07/08/2007
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