MEDICARE: MARY LYNN FELLENZ 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	OT 7400	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851432868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LYNN FELLENZ OTR

Provider Business Mailing Address
First Line	:	6593 AUTUMN WOODS BLVD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-7801
Country	:	US
Telephone Number	:	239-641-2622
Fax Number	:	239-594-7912

Provider Business Practice Location Address
First Line	:	5691 NAPLES BLVD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-2023
Country	:	US
Telephone Number	:	239-592-6100
Fax Number	:	239-592-6156

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

Provider Enumeration Date	:	02/11/2007
Last Update Date	:	01/19/2020

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