Provider Demographics
NPI:1710475371
Name:FEREBEE, JOEL AZARIAH
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:AZARIAH
Last Name:FEREBEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 PAINTED FERN RD
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-3043
Mailing Address - Country:US
Mailing Address - Phone:443-239-0689
Mailing Address - Fax:
Practice Address - Street 1:3050 MILITARY RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-1341
Practice Address - Country:US
Practice Address - Phone:443-239-0689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-28
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05212225X00000X
DEU1-0001511225XP0019X
DCOT100000168225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE45--0207291OtherOCCUPATIONAL THERAPY