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NPI Code Detail

MEDICARE: JUNE M FENNERTY OTR, CHT

MEDICARE: JUNE M FENNERTY OTR, CHT
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1225XH1200XHand Occupational Therapist004272TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18T2635OTHERTXBCBS

General Provider Information

NPI Number : 1558350017
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUNE M FENNERTY OTR, CHT
Provider Business Mailing Address
First Line : PO BOX 64240
Second Line :
City : LUBBOCK
State : TX
Zip : 79464-4240
Country : US
Telephone Number : 806-771-7451
Fax Number : 806-771-7448
Provider Business Practice Location Address
First Line : 6310 GENOA AVE STE G
Second Line :
City : LUBBOCK
State : TX
Zip : 79424-2708
Country : US
Telephone Number : 806-771-7451
Fax Number : 806-771-7448
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2005
Last Update Date : 12/23/2019

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