Provider Demographics
NPI:1891998977
Name:FENZL, KATHY MEYER (OT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:MEYER
Last Name:FENZL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:525 HWY 150
Mailing Address - City:ARROYO SECO
Mailing Address - State:NM
Mailing Address - Zip Code:87514-0280
Mailing Address - Country:US
Mailing Address - Phone:505-776-1418
Mailing Address - Fax:
Practice Address - Street 1:525 HWY 150
Practice Address - Street 2:
Practice Address - City:ARROYO SECO
Practice Address - State:NM
Practice Address - Zip Code:87514-8751
Practice Address - Country:US
Practice Address - Phone:505-776-1418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2231225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist