Individual
ALI AL-FARES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
415 BENEDUM DR, BRIDGEPORT, WV 26330-1503
(304) 842-9887
Mailing address
41 CRESTVIEW TER, BRIDGEPORT, WV 26330-1010
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1557
WV
Other
Enumeration date
10/19/2012
Last updated
10/19/2012
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