Provider Demographics
NPI:1700470929
Name:FEBO, MARIELIS (ATO)
Entity Type:Individual
Prefix:
First Name:MARIELIS
Middle Name:
Last Name:FEBO
Suffix:
Gender:F
Credentials:ATO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 AVE. SHUFFORD 109
Mailing Address - Street 2:PMB 210
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-717-5334
Mailing Address - Fax:
Practice Address - Street 1:1 AVE. SHUFFORD 109
Practice Address - Street 2:PMB 210
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-717-5334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-28
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1203224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5081662OtherDRIVER LICENSE