Provider Demographics
NPI:1891048070
Name:FAICHNEY, JEAN (MS, OT/L)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:FAICHNEY
Suffix:
Gender:F
Credentials:MS, OT/L
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:BEYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, OT/L
Mailing Address - Street 1:22593 THREE NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-3054
Mailing Address - Country:US
Mailing Address - Phone:301-862-2505
Mailing Address - Fax:301-862-2548
Practice Address - Street 1:22593 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-3054
Practice Address - Country:US
Practice Address - Phone:301-862-2505
Practice Address - Fax:301-862-2548
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07968225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist