Healthcare Provider Details

I. General information

NPI: 1952499386
Provider Name (Legal Business Name): KATHLEEN FENNELL OTR L, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

787 37TH ST SUITE E-110
VERO BEACH FL
32960-7305
US

IV. Provider business mailing address

787 37TH ST SUITE E-110
VERO BEACH FL
32960-7305
US

V. Phone/Fax

Practice location:
  • Phone: 772-562-6401
  • Fax: 772-562-6011
Mailing address:
  • Phone: 772-562-6401
  • Fax: 772-562-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT 2198
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: