Individual
MISS SUSAN ROSE FAIRBAIRN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
415 MAIN ST., MARGARETVILLE, NY 12455-0319
(845) 586-2647
(845) 586-2949
Mailing address
PO BOX 319, MARGARETVILLE, NY 12455-0319
(845) 586-2647
(845) 586-2949
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
006720
NY
Other
Enumeration date
10/20/2011
Last updated
10/20/2011
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