Provider Demographics
NPI:1619418258
Name:FAGAN, DARIAN MARIE (MS OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:DARIAN
Middle Name:MARIE
Last Name:FAGAN
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 1:33 ABERDEEN RD
Mailing Address - Street 2:APT 336B
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-1165
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33 ABERDEEN RD
Practice Address - Street 2:APT 336B
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-1165
Practice Address - Country:US
Practice Address - Phone:908-451-9778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00714600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist