Provider Demographics
NPI:1790827012
Name:FIENHAGE, RICK L (COTA)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:L
Last Name:FIENHAGE
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47340-9796
Mailing Address - Country:US
Mailing Address - Phone:765-468-8872
Mailing Address - Fax:
Practice Address - Street 1:812 W WHITE RIVER BLVD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3868
Practice Address - Country:US
Practice Address - Phone:765-286-1579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001294A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant