Provider Demographics
NPI:1679007488
Name:FEIL, CHARLENE (COTA/L)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:FEIL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11710 W HUCKLEBERRY DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-8702
Mailing Address - Country:US
Mailing Address - Phone:208-794-5724
Mailing Address - Fax:
Practice Address - Street 1:11710 W HUCKLEBERRY DR
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-8702
Practice Address - Country:US
Practice Address - Phone:208-794-5724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1513225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist