Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2619 | NH |
NPI | 1003309956 |
---|---|
Provider Name | Meagan Fallon |
First Address | Newmarket, NH 03857-2072 |
Second Address | Salem, NH 03079-3925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2018 |
Last Update Date | 14/06/2018 |