Provider Demographics
NPI:1780761148
Name:FEARS, ANNETTE RENEE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:RENEE
Last Name:FEARS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:RENEE
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15314 FALLEN GRV
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-2946
Mailing Address - Country:US
Mailing Address - Phone:210-525-8851
Mailing Address - Fax:210-525-8854
Practice Address - Street 1:6601 BLANCO RD
Practice Address - Street 2:SUITE 160
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6102
Practice Address - Country:US
Practice Address - Phone:210-525-8851
Practice Address - Fax:210-525-8854
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108483225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0051898-01Medicaid
TX0051898-02Medicaid