Provider Demographics
NPI:1952499386
Name:FENNELL, KATHLEEN (OTR L, CHT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:FENNELL
Suffix:
Gender:F
Credentials:OTR L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:787 37TH ST
Mailing Address - Street 2:SUITE E-110
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7305
Mailing Address - Country:US
Mailing Address - Phone:772-562-6401
Mailing Address - Fax:772-562-6011
Practice Address - Street 1:787 37TH ST
Practice Address - Street 2:SUITE E-110
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7305
Practice Address - Country:US
Practice Address - Phone:772-562-6401
Practice Address - Fax:772-562-6011
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 2198225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAE589ZMedicare PIN