Healthcare Provider Details

I. General information

NPI: 1497629125
Provider Name (Legal Business Name): JENNIFER FAGIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2025
Last Update Date: 10/04/2025
Certification Date: 10/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 INDIAN WELLS RD
ALAMOGORDO NM
88310-4607
US

IV. Provider business mailing address

2351 INDIAN WELLS RD
ALAMOGORDO NM
88310-4607
US

V. Phone/Fax

Practice location:
  • Phone: 575-437-3351
  • Fax: 575-437-2622
Mailing address:
  • Phone: 575-437-3351
  • Fax: 575-437-2622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT22038
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: