Individual
ALICIA FENNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1120 W DONEGAN AVE, KISSIMMEE, FL 34741-2247
(407) 847-2854
Mailing address
534 EAGLE CT, KISSIMMEE, FL 34759-4442
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
OTA 11659
FL
Other
Enumeration date
01/23/2012
Last updated
01/23/2012
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