Provider Demographics
NPI:1578333159
Name:MANUEL, FELICIA (MASTER COSMETOLOGIST)
Entity Type:Individual
Prefix:MISS
First Name:FELICIA
Middle Name:
Last Name:MANUEL
Suffix:
Gender:F
Credentials:MASTER COSMETOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8420 CENTENARY DR
Mailing Address - Street 2:
Mailing Address - City:CAMBY
Mailing Address - State:IN
Mailing Address - Zip Code:46113-8006
Mailing Address - Country:US
Mailing Address - Phone:470-886-2666
Mailing Address - Fax:
Practice Address - Street 1:8420 CENTENARY DR
Practice Address - Street 2:
Practice Address - City:CAMBY
Practice Address - State:IN
Practice Address - Zip Code:46113-8006
Practice Address - Country:US
Practice Address - Phone:470-886-2666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO129940335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier