Provider Demographics
NPI:1376635326
Name:FEHR, THEODORE W (OT)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:W
Last Name:FEHR
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 SEVERIN DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3806
Mailing Address - Country:US
Mailing Address - Phone:619-589-2606
Mailing Address - Fax:619-464-0900
Practice Address - Street 1:2700 N MAIN ST STE 340
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6638
Practice Address - Country:US
Practice Address - Phone:714-953-7330
Practice Address - Fax:949-727-2193
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 6216225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACH719ZOtherMEDICARE PTAN