Provider Demographics
NPI:1689125569
Name:FEOLA, MICHELINA MARY
Entity Type:Individual
Prefix:
First Name:MICHELINA
Middle Name:MARY
Last Name:FEOLA
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 1:777 DEDHAM ST
Mailing Address - Street 2:BOX # 663
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3323
Mailing Address - Country:US
Mailing Address - Phone:203-394-8352
Mailing Address - Fax:508-634-6984
Practice Address - Street 1:321 FORTUNE BLVD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1750
Practice Address - Country:US
Practice Address - Phone:203-394-8352
Practice Address - Fax:508-478-0207
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist