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Contact Information

THERESA FAIRBANKS, COTA/L
1215 KINSLEY AVE.
ORANGE PARK, FL32073
 Phone: 190-426-9892
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Occupational Therapy Assistant

224Z00000X
Indicates primary specialty

NPI Profile & details for THERESA FAIRBANKS · (Female)

NPI # 1427398684
Status Active
Credentials COTA/L (Licensed Certified Occupational Therapy Assistant )
Entity Individual
Enumeration date 02/26/2013
Last updated 02/26/2013 - About 13 years ago
Sole proprietor 1 Yes
Identifiers
  • FL License # OTA9801
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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