Most Relevant Information
Provider Data
| NPI Number: | 1003642414 |
| Provider Name: | TODD FADER OT |
| Entity Type: | Individual |
| Taxonomy Code: | 225X00000X |
| Specialty: | Occupational Therapist |
| License Number: | 26870 |
Most Important Dates
| Enumeration Date: | 09/11/2024 |
| Last Updated: | 09/11/2024 |
Provider Practice Location
79440 CORPORATE CENTER DR STE 112
LA QUINTA
CA
922537243
Practice Location Phone/Fax
| Phone: | 7607719054 |
| Fax: | 7607719057 |
Provider Mailing Location
1650 LYNDON FARM CT STE 300
LOUISVILLE
KY
402235005
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |