Healthcare Provider Details

I. General information

NPI: 1437469590
Provider Name (Legal Business Name): COLEEN ATHERLEY-FAHEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 08/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 BETTS RD
ORRINGTON ME
04474-3842
US

IV. Provider business mailing address

296 BETTS RD
ORRINGTON ME
04474-3842
US

V. Phone/Fax

Practice location:
  • Phone: 207-478-8627
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP1164
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: