MEDICARE: CARON FAHERTY O.T.

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	225XH1200X	Hand Occupational Therapist	OT1145	FL

General Provider Information

NPI Number	:	1710013651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARON FAHERTY O.T.

Provider Business Mailing Address
First Line	:	690 JENSEN BEACH BLVD
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-4750
Country	:	US
Telephone Number	:	772-708-3751
Fax Number	:	772-225-0843

Provider Business Practice Location Address
First Line	:	690 JENSEN BEACH BLVD
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-4750
Country	:	US
Telephone Number	:	772-708-3751
Fax Number	:	772-225-0843

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	09/29/2008

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