Individual
MARYGRACE C FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
252 GREEVES RD, NEW HAMPTON, NY 10958-3926
(845) 374-2180
Mailing address
252 GREEVES RD, NEW HAMPTON, NY 10958-3926
(845) 374-2180
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
007650-1
NY
Other
Enumeration date
08/04/2010
Last updated
08/04/2010
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