Individual
BAILEY FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
130 LOMOND CT, UTICA, NY 13502-5951
(315) 724-4286
Mailing address
3052 STATE ROUTE 17C, OWEGO, NY 13827-5400
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
P91163
NY
Other
Enumeration date
11/07/2013
Last updated
11/07/2013
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