Individual
KATHLEEN FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
54 BAY STATE AVE, SOMERVILLE, MA 02144-2134
(518) 496-5717
Mailing address
54 BAY STATE AVE, SOMERVILLE, MA 02144-2134
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
11367
MA
Other
Enumeration date
10/03/2014
Last updated
10/03/2014
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