Provider Demographics
NPI:1912212937
Name:FABER, ELLEN D (NCMT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:D
Last Name:FABER
Suffix:
Gender:F
Credentials:NCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2642 OPEQUON BEND
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-7571
Mailing Address - Country:US
Mailing Address - Phone:248-227-8997
Mailing Address - Fax:
Practice Address - Street 1:2642 OPEQUON BEND
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-7571
Practice Address - Country:US
Practice Address - Phone:248-227-8997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist