Provider Demographics
NPI:1457478935
Name:FELICE, MARCIAL MARIE (LMT)
Entity Type:Individual
Prefix:MS
First Name:MARCIAL
Middle Name:MARIE
Last Name:FELICE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 E TIETAN ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4538
Mailing Address - Country:US
Mailing Address - Phone:509-540-2058
Mailing Address - Fax:
Practice Address - Street 1:2 E POPLAR ST # 102
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3009
Practice Address - Country:US
Practice Address - Phone:509-540-2058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2024-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023109225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist