Carla Jo Fenna, OTRL

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Practice address

402 Jayde Place
Poplar Grove, IL 61065-8314

Phone

(815) 765-2715

Fax

(815) 765-2715

NPI assigned

Aug 31, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Rockford Health Physicians

  dba Mercyhealth Physicians

  • Multi-Specialty Clinic/Center
  • Rockford, IL
  • NPI 1043242886
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609987395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 JAYDE PLACE",
            "city": "POPLAR GROVE",
            "state": "IL",
            "postal_code": "610658314",
            "telephone_number": "815-765-2715",
            "fax_number": "815-765-2715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 JAYDE PLACE",
            "city": "POPLAR GROVE",
            "state": "IL",
            "postal_code": "610658314",
            "telephone_number": "815-765-2715",
            "fax_number": "815-765-2715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENNA",
        "first_name": "CARLA",
        "middle_name": "JO",
        "name_prefix": "Ms.",
        "credential": "OTRL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EARLY INTERVENTION",
            "identifier": "CF02520398P",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffry Stephen Clow, SLP
• Patricia J. Cox, LCSW, PHD
• Mark Currier
• Troy Michael Doetch, MD
• Felker Pharmacy Inc (Snyder Pharmacy)
• Gemma Fletcher
• Jennifer Gallagher, PTA
• Laura Grant, PHD, CF-SLP
• Hoffman Chiropractic and Wellness Clinic
• Christopher Hoffman, D.C.

• Occupational Therapist in Poplar Grove, IL
• Providers in Poplar Grove, IL by specialty
• Occupational Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.