Organization
MASONICARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN FAGAN OTR/L (REHAB DIRECTOR)
(203) 679-6247
Entity
Organization
Contact information
Practice address
22 MASONIC AVE, REHAB DEPARTMENT, WALLINGFORD, CT 06492-3048
(203) 679-5900
(203) 679-6142
Mailing address
22 MASONIC AVE, REHAB DEPARTMENT, WALLINGFORD, CT 06492-3048
(203) 679-5900
(203) 679-6142
Taxonomy
Speciality
Code
Description
License number
State
283X00000X
Rehabilitation Hospital
Primary
003288
CT
Other
Enumeration date
08/12/2010
Last updated
08/12/2010
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