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General NPI Number Information
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NPI Number | 1851432868
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Entity Type | Individual
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Provider Name | MARY LYNN FELLENZ OTR
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Gender | Female
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Dates
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Enumeration Date | 02/11/2007
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Last Update Date | 01/19/2020
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Provider Practice Location Address
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Address Line | 5691 NAPLES BLVD
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City | NAPLES
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State | FL
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Zip | 34109-2023
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Country | US
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Telephone | 239-592-6100
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Fax | 239-592-6156
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Provider Business Mailing Address
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Address Line | 6593 AUTUMN WOODS BLVD
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City | NAPLES
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State | FL
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Zip | 34109-7801
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Country | US
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Telephone | 239-641-2622
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Fax | 239-594-7912
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT 7400
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License Number State | FL
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