Healthcare Provider Details

I. General information

NPI: 1750423067
Provider Name (Legal Business Name): CAROL C FIENHAGE OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 W WHITE RIVER BLVD
MUNCIE IN
47303-3868
US

IV. Provider business mailing address

412 N MAIN ST
FARMLAND IN
47340-9796
US

V. Phone/Fax

Practice location:
  • Phone: 765-468-8872
  • Fax:
Mailing address:
  • Phone: 765-468-8872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31002888A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: