Provider Demographics
NPI:1003540196
Name:JOLEEN R. FERNALD PEDIATRIC THERAPY SERVICES
Entity Type:Organization
Organization Name:JOLEEN R. FERNALD PEDIATRIC THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNALD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CCC-SLP, BCS-CL
Authorized Official - Phone:603-498-7825
Mailing Address - Street 1:1820 KINSMERE DR
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4531
Mailing Address - Country:US
Mailing Address - Phone:603-498-7825
Mailing Address - Fax:
Practice Address - Street 1:2114 SEVEN SPRINGS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-3934
Practice Address - Country:US
Practice Address - Phone:603-498-7825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty