Provider Demographics
NPI:1790967719
Name:FELIX, KRISTEN MCDONALD
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:MCDONALD
Last Name:FELIX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:FELIX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICENSED MASSAGE THE
Mailing Address - Street 1:54 MT VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569-9555
Mailing Address - Country:US
Mailing Address - Phone:585-786-2834
Mailing Address - Fax:
Practice Address - Street 1:54 MT VIEW AVE
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-9555
Practice Address - Country:US
Practice Address - Phone:585-786-2834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010719225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist