Provider Demographics
NPI:1154407518
Name:ALFARO, JOAN MARIE (OTRL)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:MARIE
Last Name:ALFARO
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 DR WOLF ROAD
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:TN
Mailing Address - Zip Code:38581
Mailing Address - Country:US
Mailing Address - Phone:931-815-2055
Mailing Address - Fax:931-506-5065
Practice Address - Street 1:203 OAK PARK DRIVE
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110
Practice Address - Country:US
Practice Address - Phone:931-473-6039
Practice Address - Fax:931-506-5065
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN106225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist