Basic Information
| Provider Information | |||||||||
| NPI: | 1831428218 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FELICITAS | ||||||||
| FirstName: | MARRIETA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 CHASE ST | ||||||||
| Address2: | |||||||||
| City: | BYHALIA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386117395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6628383670 | ||||||||
| FaxNumber: | 6628383740 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 CHASE ST | ||||||||
| Address2: | |||||||||
| City: | BYHALIA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386117395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6628383670 | ||||||||
| FaxNumber: | 6628383740 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2009 | ||||||||
| LastUpdateDate: | 12/15/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT2187 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.