Provider Demographics
NPI:1023592698
Name:FELICIANO, NELLIE
Entity type:Individual
Prefix:
First Name:NELLIE
Middle Name:
Last Name:FELICIANO
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 1:4743 GRASSELLI ST
Mailing Address - Street 2:
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-3531
Mailing Address - Country:US
Mailing Address - Phone:219-678-0582
Mailing Address - Fax:219-398-4225
Practice Address - Street 1:221 US HIGHWAY 41 STE H
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1278
Practice Address - Country:US
Practice Address - Phone:219-322-1600
Practice Address - Fax:219-322-9786
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist