Provider Demographics
NPI:1265673131
Name:FEJES, LARA (MT-BC)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:FEJES
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5333
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02880-5333
Mailing Address - Country:US
Mailing Address - Phone:401-345-1738
Mailing Address - Fax:401-885-2456
Practice Address - Street 1:159 WAMPANOAG RD
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-4620
Practice Address - Country:US
Practice Address - Phone:401-345-1738
Practice Address - Fax:401-885-2456
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYF00499996225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist