Provider Demographics
NPI:1679681316
Name:FELLER, CAROLE LYNN (PT)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:LYNN
Last Name:FELLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 STEIN AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-1731
Mailing Address - Country:US
Mailing Address - Phone:608-438-8717
Mailing Address - Fax:608-242-9576
Practice Address - Street 1:4525 STEIN AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-1731
Practice Address - Country:US
Practice Address - Phone:608-438-8717
Practice Address - Fax:608-242-9576
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5952-0242251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics