Healthcare Provider Details

I. General information

NPI: 1386721884
Provider Name (Legal Business Name): FENGYI KUO MA, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 PADDOCK RD
GREENWOOD IN
46142-9078
US

IV. Provider business mailing address

448 PADDOCK RD
GREENWOOD IN
46142-9078
US

V. Phone/Fax

Practice location:
  • Phone: 317-885-8019
  • Fax: 317-885-8019
Mailing address:
  • Phone: 317-885-8019
  • Fax: 317-885-8019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31003984A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: