Provider Demographics
NPI:1972883668
Name:FELKER, ALICIA BURNAM (ATC, LAT, CSCS)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:BURNAM
Last Name:FELKER
Suffix:
Gender:F
Credentials:ATC, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 NEWBURY ST
Mailing Address - Street 2:REHAB SERVICES
Mailing Address - City:RIPON
Mailing Address - State:WI
Mailing Address - Zip Code:54971-1730
Mailing Address - Country:US
Mailing Address - Phone:920-748-9138
Mailing Address - Fax:
Practice Address - Street 1:933 NEWBURY ST
Practice Address - Street 2:REHAB SERVICES
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54971-1730
Practice Address - Country:US
Practice Address - Phone:920-748-9138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12020392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer