Provider Demographics
NPI:1598044141
Name:FEAZELL, MARLA
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:FEAZELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1094 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-1364
Mailing Address - Country:US
Mailing Address - Phone:865-458-8900
Mailing Address - Fax:865-458-8626
Practice Address - Street 1:1094 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-1364
Practice Address - Country:US
Practice Address - Phone:865-458-8900
Practice Address - Fax:865-458-8626
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000113224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant