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General NPI Number Information
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NPI Number | 1376864843
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Entity Type | Individual
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Provider Name | MS. LORI ANN FADELY
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Gender | Female
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Dates
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Enumeration Date | 06/18/2010
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 1411 ZION CHURCH RD
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City | MAURERTOWN
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State | VA
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Zip | 22644
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Country | US
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Telephone | 540-533-9651
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Fax |
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Provider Business Mailing Address
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Address Line | 1411 ZION CHURCH RD
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City | MAURERTOWN
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State | VA
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Zip | 22644
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Country | US
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Telephone | 540-533-9651
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | CP-391602
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | CP-391602
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License Number State | VA
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