Basic Information
| Provider Information | |||||||||
| NPI: | 1619917556 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARSHALL | ||||||||
| FirstName: | FELECIA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1560 E MAPLE RD | ||||||||
| Address2: | SUITE 400-CREDENTIALING | ||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480831138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137454600 | ||||||||
| FaxNumber: | 3137451063 | ||||||||
| Practice Location | |||||||||
| Address1: | 261 MACK AVE | ||||||||
| Address2: | REHABILITATION INSTITUTE OF MI | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137454600 | ||||||||
| FaxNumber: | 3137451063 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 10/27/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 5601004559 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | 5601004559 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.