MEDICARE: PATRICK FETHIERE

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	106S00000X	Behavior Technician		FL

General Provider Information

NPI Number	:	1649133851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK FETHIERE

Provider Business Mailing Address
First Line	:	4747 W WATERS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-1450
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4320 W EL PRADO BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-8498
Country	:	US
Telephone Number	:	813-461-5380
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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Directions to “ PATRICK FETHIERE ” Practice Location

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