Provider Demographics
NPI:1326713876
Name:FELS, THOMAS ROBERT
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ROBERT
Last Name:FELS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1739
Mailing Address - Country:US
Mailing Address - Phone:516-314-6315
Mailing Address - Fax:
Practice Address - Street 1:461 N YUCCA CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-4551
Practice Address - Country:US
Practice Address - Phone:480-366-4948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities