MEDICARE: FYFE & FEDERICK LLC

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
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1568863124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FYFE & FEDERICK LLC

Provider Business Mailing Address
First Line	:	258 S SAM HOUSTON BLVD
Second Line	:
City	:	SAN BENITO
State	:	TX
Zip	:	78586-3867
Country	:	US
Telephone Number	:	956-361-4550
Fax Number	:	888-897-1957

Provider Business Practice Location Address
First Line	:	258 S SAM HOUSTON BLVD
Second Line	:
City	:	SAN BENITO
State	:	TX
Zip	:	78586-3867
Country	:	US
Telephone Number	:	956-361-4550
Fax Number	:	888-897-1957

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	MINERVA IDALIA GARZA
Credential	:	OTR
Telephone Number	:	956-361-4550

Provider Enumeration Date	:	09/12/2014
Last Update Date	:	04/21/2015

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Directions to “FYFE & FEDERICK LLC ” Practice Location

Language	Start Address	Practice Location

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