MEDICARE: DEBRA ANN FAGAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	520100500	MI

General Provider Information

NPI Number	:	1649761768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA ANN FAGAN

Provider Business Mailing Address
First Line	:	137 N ELK ST
Second Line	:
City	:	SANDUSKY
State	:	MI
Zip	:	48471-1129
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	137 N ELK ST
Second Line	:
City	:	SANDUSKY
State	:	MI
Zip	:	48471-1129
Country	:	US
Telephone Number	:	810-648-3017
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2018
Last Update Date	:	05/24/2018

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Directions to “ DEBRA ANN FAGAN ” Practice Location

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