Individual
KELLY FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
400 PENN ST, LANSDALE, PA 19446-2840
(215) 368-2700
Mailing address
325 MADISON ST APT A306, LANSDALE, PA 19446-2144
(610) 772-7934
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OC019571
PA
Other
Enumeration date
08/02/2024
Last updated
08/02/2024
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