MEDICARE: MRS. KRISTIE ANN FOX-WARREN OTR

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	696634	MI

General Provider Information

NPI Number	:	1326142555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTIE ANN FOX-WARREN OTR

Provider Business Mailing Address
First Line	:	6354 3RD ST
Second Line	:
City	:	CASS CITY
State	:	MI
Zip	:	48726-1337
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6190 HOSPITAL DR STE 101
Second Line	:
City	:	CASS CITY
State	:	MI
Zip	:	48726-1072
Country	:	US
Telephone Number	:	989-872-2084
Fax Number	:

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

Provider Enumeration Date	:	09/08/2006
Last Update Date	:	07/08/2007

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