Individual
JAMELLA FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4619 CHESTER AVE APT B210, PHILADELPHIA, PA 19143-3683
(267) 481-6632
Mailing address
4619 CHESTER AVE APT B210, PHILADELPHIA, PA 19143-3683
(267) 481-6632
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OC020735
PA
Other
Enumeration date
04/25/2025
Last updated
04/25/2025
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