Individual
JEAN FETNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
8901 BLUEWATER RD NW, JIMMY CARTER MS, ALBUQUERQUE, NM 87121-2024
(505) 833-7540
Mailing address
1334 WYOMING BLVD NE, JIMMY CARTER MS, ALBUQUERQUE, NM 87112-5067
(505) 292-3317
(505) 217-0317
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
377
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
52050327
—
NM
Enumeration date
03/13/2007
Last updated
06/22/2016
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