Individual
SUSAN FUQUA FENWICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3473 LONDON PIKE, PHILPOT, KY 42366-9344
(270) 302-1485
Mailing address
3473 LONDON PIKE, PHILPOT, KY 42366-9344
(270) 302-1485
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
08/05/2019
Last updated
08/05/2019
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