Basic Information
| Provider Information | |||||||||
| NPI: | 1376635326 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FEHR | ||||||||
| FirstName: | THEODORE | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | O.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5905 SEVERIN DR | ||||||||
| Address2: | |||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919423806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195892606 | ||||||||
| FaxNumber: | 6194640900 | ||||||||
| Practice Location | |||||||||
| Address1: | 2700 N MAIN ST STE 340 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927056638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149537330 | ||||||||
| FaxNumber: | 9497272193 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 01/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT 6216 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | CH719Z | 01 | CA | MEDICARE PTAN | OTHER |