Provider Demographics
NPI:1689421653
Name:FERGUSON OCCUPATIONAL THERAPY LLC
Entity type:Organization
Organization Name:FERGUSON OCCUPATIONAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR/L, CAPS
Authorized Official - Phone:260-479-0952
Mailing Address - Street 1:836 E WALLEN RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2836
Mailing Address - Country:US
Mailing Address - Phone:260-479-0952
Mailing Address - Fax:
Practice Address - Street 1:836 E WALLEN RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2836
Practice Address - Country:US
Practice Address - Phone:260-479-0952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty