Individual
KATIE FANNING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
393 NORTH ST, SPRINGVILLE, NY 14141-9652
(716) 592-9331
(716) 592-4683
Mailing address
393 NORTH ST, SPRINGVILLE, NY 14141-9652
(716) 592-9331
(716) 592-4683
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
1341458
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1341458
—
NY
Enumeration date
03/07/2016
Last updated
03/07/2016
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