Provider Demographics
NPI:1396990289
Name:FEITOSA, MARILEIDE
Entity type:Individual
Prefix:
First Name:MARILEIDE
Middle Name:
Last Name:FEITOSA
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 1:2122 NOVA VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33317-7007
Mailing Address - Country:US
Mailing Address - Phone:954-337-1440
Mailing Address - Fax:954-337-1440
Practice Address - Street 1:2122 NOVA VILLAGE DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33317-7007
Practice Address - Country:US
Practice Address - Phone:954-337-1440
Practice Address - Fax:954-337-1440
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13383225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist