Healthcare Provider Details

I. General information

NPI: 1316865124
Provider Name (Legal Business Name): MAGEN FORTIN OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W MAIN ST
CHESTER CT
06412-1066
US

IV. Provider business mailing address

251 INGALLS RD
UNADILLA NY
13849-2114
US

V. Phone/Fax

Practice location:
  • Phone: 860-544-5228
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number6709
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: