Marie Fanham, LMT

NPI #1295189017 in Brockport, New York

Provider Information

NPI Number: 1295189017
Entity Type: Individual
Name: Marie Fanham, LMT
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Massage Therapist
Credential: LMT
Enumeration Date: Apr 18, 2016
Last Updated: Apr 18, 2016

Practice Location

Address: 29 CLINTON ST
City: Brockport
State: New York
ZIP Code: 14420-1803
Phone: (585) 637-3126

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X	Primary

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