Provider Demographics
NPI:1558350017
Name:FENNERTY, JUNE M (OTR, CHT)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:M
Last Name:FENNERTY
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64240
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79464-4240
Mailing Address - Country:US
Mailing Address - Phone:806-771-7451
Mailing Address - Fax:806-771-7448
Practice Address - Street 1:6310 GENOA AVE STE G
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2708
Practice Address - Country:US
Practice Address - Phone:806-771-7451
Practice Address - Fax:806-771-7448
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004272225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T2635OtherBCBS
TX8C2187Medicare PIN