Provider Demographics
NPI:1770039679
Name:FEUILLE, MARIE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:FEUILLE
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 1:3275 MAIN ST APT 104
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4231
Mailing Address - Country:US
Mailing Address - Phone:718-578-1300
Mailing Address - Fax:
Practice Address - Street 1:3275 MAIN ST APT 104
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4231
Practice Address - Country:US
Practice Address - Phone:718-578-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004297225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist