Provider Demographics
NPI:1568863124
Name:FYFE & FEDERICK LLC
Entity Type:Organization
Organization Name:FYFE & FEDERICK LLC
Other - Org Name:FUN & FUNCTIONAL THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MINERVA
Authorized Official - Middle Name:IDALIA
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:956-361-4550
Mailing Address - Street 1:258 S SAM HOUSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-3867
Mailing Address - Country:US
Mailing Address - Phone:956-361-4550
Mailing Address - Fax:888-897-1957
Practice Address - Street 1:258 S SAM HOUSTON BLVD
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-3867
Practice Address - Country:US
Practice Address - Phone:956-361-4550
Practice Address - Fax:888-897-1957
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FYFE & FEDERICK LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-12
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty