Individual
MRS. MACKENNA G FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4362 GRIDER RD, ELMA, NY 14059
(716) 652-3000
Mailing address
443 SUMNER RD, CORFU, NY 14036-9566
(585) 409-0693
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
008973
NY
Other
Enumeration date
09/16/2021
Last updated
09/16/2021
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