Provider Demographics
NPI:1316611304
Name:FARIS, TOD GARRETT (OTD, OTR/L)
Entity type:Individual
Prefix:MR
First Name:TOD
Middle Name:GARRETT
Last Name:FARIS
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 NW BUCKINGHAM LN UNIT 213
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-0040
Mailing Address - Country:US
Mailing Address - Phone:641-856-7906
Mailing Address - Fax:
Practice Address - Street 1:2455 SW STATE ST STE 105
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-1277
Practice Address - Country:US
Practice Address - Phone:515-963-4528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XP0200X
IA110097225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics