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General NPI Number Information
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NPI Number | 1003540196
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Entity Type | Organization
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Legal Business Name | JOLEEN R. FERNALD PEDIATRIC THERAPY SERVICES
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Dates
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Enumeration Date | 07/13/2022
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 2114 SEVEN SPRINGS BLVD STE 200
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City | NEW PORT RICHEY
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State | FL
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Zip | 34655-3934
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Country | US
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Telephone | 603-498-7825
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Fax |
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Provider Business Mailing Address
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Address Line | 1820 KINSMERE DR
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City | TRINITY
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State | FL
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Zip | 34655-4531
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Country | US
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Telephone | 603-498-7825
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOLEEN FERNALD
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Credential | PHD, CCC-SLP, BCS-CL
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Telephone | 603-498-7825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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