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Individual

MRS. AMANDA MARIE GANNON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS OTR/L

Contact information

Practice address
597 3RD AVE, TROY, NY 12182-2509
(518) 233-0703
Mailing address
1371 DIVISION ST, CHARLTON, NY 12019-2907
(518) 424-8873

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
016997-1
NY

Other

Enumeration date
11/29/2011
Last updated
11/13/2012
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