Provider Demographics
NPI:1447583216
Name:FAGAN, VALERIE (NCTMB)
Entity Type:Individual
Prefix:PROF
First Name:VALERIE
Middle Name:
Last Name:FAGAN
Suffix:
Gender:F
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:CO
Mailing Address - Zip Code:80420-0264
Mailing Address - Country:US
Mailing Address - Phone:970-668-1310
Mailing Address - Fax:970-668-1301
Practice Address - Street 1:60 MAIN STREET
Practice Address - Street 2:SUITE H
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-1310
Practice Address - Fax:970-668-1301
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT 4497225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist