Provider Demographics
NPI:1518403609
Name:FEASTER, LAURA ALICIA (MT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ALICIA
Last Name:FEASTER
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8811 E. HAMPTON AVE.
Mailing Address - Street 2:3J
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231
Mailing Address - Country:US
Mailing Address - Phone:720-512-5123
Mailing Address - Fax:720-512-5124
Practice Address - Street 1:8811 E. HAMPTON AVE.
Practice Address - Street 2:3J
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231
Practice Address - Country:US
Practice Address - Phone:720-512-5123
Practice Address - Fax:720-512-5124
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0014948225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist