MEDICARE: MS. BETH ANN FABEL OTR/L

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	OT00004362	WA

General Provider Information

NPI Number	:	1891952511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BETH ANN FABEL OTR/L

Provider Business Mailing Address
First Line	:	10713 NE 15TH ST
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98664-4358
Country	:	US
Telephone Number	:	360-989-4803
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 NW 78TH ST
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98665-7904
Country	:	US
Telephone Number	:	360-604-5678
Fax Number	:

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

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	02/22/2011

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