Individual
MS. CARLA JO FENNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
402 JAYDE PLACE, POPLAR GROVE, IL 61065-8314
(815) 765-2715
(815) 765-2715
Mailing address
402 JAYDE PLACE, POPLAR GROVE, IL 61065-8314
(815) 765-2715
(815) 765-2715
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CF02520398P
EARLY INTERVENTION
IL
Enumeration date
08/31/2006
Last updated
07/08/2007
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