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Individual

MRS. EVELYN FANO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
OTR

Contact information

Practice address
101 GLENBROOK RD, FREEHOLD, NJ 07728-1512
(732) 294-7428
Mailing address
101 GLENBROOK RD, FREEHOLD, NJ 07728-1512
(732) 294-7428

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
46TR00071100
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
46TR00071100
OCCUPATIONAL THERAPIST
NJ
Enumeration date
10/30/2015
Last updated
10/30/2015
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