Doctor Name: | LINDA KAY FAIRCHILD |
NPI Number: | 1720010382 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | OWNER, QMRP, OTR/L |
License Number: | 810345-1-WS |
Business Practice Address: | 6718 Odean Ave Ne Otsego, MN - 553306724 |
Business Phone Number: | 7632741070 |
Business Fax Number: | 7632741071 |
Mailing Address: | 6718 Odean Ave Ne, OTSEGO |
State: | MN |
Postal Code: | 553306724 |
Phone Number: | 7632741070 |
Fax Number: | 7632741071 |
NPI Enumeration Date: | 07/06/2006 |
NPI Last Update Date: | 05/11/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | 810345-1-WS |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |