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NPI Code Detail

MEDICARE: JOANNE FAHEY

MEDICARE: JOANNE FAHEY
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
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1861820490
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOANNE FAHEY
Provider Business Mailing Address
First Line : 4420 NE JACKSONVILLE RD
Second Line :
City : OCALA
State : FL
Zip : 34479-2424
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1408 NW 6TH ST
Second Line :
City : GAINESVILLE
State : FL
Zip : 32601-4020
Country : US
Telephone Number : 352-373-4411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2013
Last Update Date : 10/16/2013

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Directions to “ JOANNE FAHEY ” Practice Location

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