Individual
MARIE FANHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
29 CLINTON ST, BROCKPORT, NY 14420-1803
(585) 637-3126
Mailing address
29 CLINTON ST, BROCKPORT, NY 14420-1803
(585) 637-3126
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
029413-1
NY
Other
Enumeration date
04/18/2016
Last updated
04/18/2016
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