Provider Demographics
NPI:1255464285
Name:FARNER-OREN, MARY J (COTA)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:J
Last Name:FARNER-OREN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BLANCHARD ST
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:WI
Mailing Address - Zip Code:53534-1501
Mailing Address - Country:US
Mailing Address - Phone:608-884-8831
Mailing Address - Fax:
Practice Address - Street 1:11 BLANCHARD ST
Practice Address - Street 2:
Practice Address - City:EDGERTON
Practice Address - State:WI
Practice Address - Zip Code:53534-1501
Practice Address - Country:US
Practice Address - Phone:608-884-8831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI404-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI404-027OtherSTATE LICIENCE