Provider Demographics
NPI:1437646585
Name:FANTACONE, KOREY LEIGH (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KOREY
Middle Name:LEIGH
Last Name:FANTACONE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 WEST 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126
Mailing Address - Country:US
Mailing Address - Phone:315-456-8260
Mailing Address - Fax:
Practice Address - Street 1:1005 VILLAGE BLVD S
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-3369
Practice Address - Country:US
Practice Address - Phone:315-215-6991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-15
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist