MEDICARE: MARY KATHLEEN FEAREY OTR/L

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	OT 00002945	WA

General Provider Information

NPI Number	:	1962842641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY KATHLEEN FEAREY OTR/L

Provider Business Mailing Address
First Line	:	4704 NE NORTH TOLO RD
Second Line	:
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-3460
Country	:	US
Telephone Number	:	206-842-9319
Fax Number	:

Provider Business Practice Location Address
First Line	:	4704 NE NORTH TOLO RD
Second Line	:
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-3460
Country	:	US
Telephone Number	:	206-842-9319
Fax Number	:

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

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	06/26/2013

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