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NPI Code Detail

MEDICARE: KELLI ANNE FARHAT OT

MEDICARE: KELLI ANNE FARHAT OT
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
1225X00000XOccupational Therapist21360CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619495751
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLI ANNE FARHAT OT
Provider Business Mailing Address
First Line : 4445 EASTGATE MALL
Second Line : STE 105
City : SAN DIEGO
State : CA
Zip : 92121-1979
Country : US
Telephone Number : 858-357-9450
Fax Number : 858-412-6376
Provider Business Practice Location Address
First Line : 5446 N ACADEMY BLVD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-3644
Country : US
Telephone Number : 719-598-5555
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2017
Last Update Date : 07/21/2022

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Directions to “ KELLI ANNE FARHAT OT” Practice Location

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