National Provider Identifier
Mackenna G Fagan
Mackenna G Fagan is listed in the NPPES registry with a primary specialty of Occupational Therapy Assistant in Elma, NY and a listed phone number of (716) 652-3000.
Profile Overview
- NPI
- 1396415857
- Provider Type
- Individual
- Primary Specialty
- Occupational Therapy Assistant
- Enumeration Date
- September 16, 2021
- Last Updated
- September 16, 2021
Practice Location
- 4362 Grider RD
- Elma, NY 14059
Phone: (716) 652-3000
Mailing Address
- 443 Sumner RD
- Corfu, NY 14036-9566
Specialties
- Occupational Therapy Assistant (224Z00000X)
Full Record
- NPI
- 1396415857
- Entity Type
- Individual
- Last Name
- Fagan
- First Name
- Mackenna
- Middle Name
- G
- Name Prefix
- Mrs.
- Mailing Street Address
- 443 Sumner RD
- Mailing City
- Corfu
- Mailing State
- NY
- Mailing ZIP Code
- 14036-9566
- Mailing Country
- US
- Mailing Phone
- (585) 409-0693
- Practice Street Address
- 4362 Grider RD
- Practice City
- Elma
- Practice State
- NY
- Practice ZIP Code
- 14059
- Practice Country
- US
- Practice Phone
- (716) 652-3000
- Enumeration Date
- September 16, 2021
- Last Updated
- September 16, 2021
- Sex
- Female
- Sole Proprietor
- Yes
- Certification Date
- September 08, 2021
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Occupational Therapy Assistant (224Z00000X)