Provider Demographics
NPI:1386011328
Name:FAHY, WILLIAM D III (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:D
Last Name:FAHY
Suffix:III
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3208
Mailing Address - Country:US
Mailing Address - Phone:203-795-0835
Mailing Address - Fax:203-795-0836
Practice Address - Street 1:225 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3208
Practice Address - Country:US
Practice Address - Phone:203-795-0835
Practice Address - Fax:203-795-0836
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000560224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant