Provider Demographics
NPI:1235105578
Name:DUDLEY, FELECIA LASHAWN (OTR)
Entity Type:Individual
Prefix:MS
First Name:FELECIA
Middle Name:LASHAWN
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E HAZEL ST
Mailing Address - Street 2:UNIT #2
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-3125
Mailing Address - Country:US
Mailing Address - Phone:310-671-4012
Mailing Address - Fax:
Practice Address - Street 1:333 E HAZEL ST
Practice Address - Street 2:UNIT #2
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302-3125
Practice Address - Country:US
Practice Address - Phone:310-671-4012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 1795225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist