MEDICARE: JOLEEN R. FERNALD PEDIATRIC THERAPY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	224Z00000X	Occupational Therapy Assistant
2	225100000X	Physical Therapist
3	225200000X	Physical Therapy Assistant
4	225X00000X	Occupational Therapist
5	2355S0801X	Speech-Language Assistant
6	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1003540196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOLEEN R. FERNALD PEDIATRIC THERAPY SERVICES

Provider Business Mailing Address
First Line	:	1820 KINSMERE DR
Second Line	:
City	:	TRINITY
State	:	FL
Zip	:	34655-4531
Country	:	US
Telephone Number	:	603-498-7825
Fax Number	:

Provider Business Practice Location Address
First Line	:	2114 SEVEN SPRINGS BLVD STE 200
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-3934
Country	:	US
Telephone Number	:	603-498-7825
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOLEEN FERNALD
Credential	:	PHD, CCC-SLP, BCS-CL
Telephone Number	:	603-498-7825

Provider Enumeration Date	:	07/13/2022
Last Update Date	:	07/13/2022

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