Provider Demographics
NPI:1437572823
Name:FICKEN, MARY C (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:C
Last Name:FICKEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2783 RIDGEWAY DR SE
Mailing Address - Street 2:
Mailing Address - City:TURNER
Mailing Address - State:OR
Mailing Address - Zip Code:97392-9370
Mailing Address - Country:US
Mailing Address - Phone:541-913-4740
Mailing Address - Fax:
Practice Address - Street 1:2783 RIDGEWAY DR SE
Practice Address - Street 2:
Practice Address - City:TURNER
Practice Address - State:OR
Practice Address - Zip Code:97392-9370
Practice Address - Country:US
Practice Address - Phone:541-913-4740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR306415225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist