MEDICARE: CAROL C FIENHAGE OTR

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	31002888A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000105227	OTHER	IN	ANTHEM BCBS

General Provider Information

NPI Number	:	1750423067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL C FIENHAGE OTR

Provider Business Mailing Address
First Line	:	412 N MAIN ST
Second Line	:
City	:	FARMLAND
State	:	IN
Zip	:	47340-9796
Country	:	US
Telephone Number	:	765-468-8872
Fax Number	:

Provider Business Practice Location Address
First Line	:	812 W WHITE RIVER BLVD
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47303-3868
Country	:	US
Telephone Number	:	765-468-8872
Fax Number	:

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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Directions to “ CAROL C FIENHAGE OTR” Practice Location

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