Individual
THERESA FAIRBANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1215 KINSLEY AVE., ORANGE PARK, FL 32073
(190) 426-9892
Mailing address
1215 KINSLEY AVE., ORANGE PARK, FL 32073
(190) 426-9892
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA9801
FL
Other
Enumeration date
02/26/2013
Last updated
02/26/2013
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