MEDICARE: JOSEPHINE MARIE FEIJOO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1316151038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPHINE MARIE FEIJOO

Provider Business Mailing Address
First Line	:	PO BOX 709
Second Line	:
City	:	HIGHLAND
State	:	MI
Zip	:	48357-0709
Country	:	US
Telephone Number	:	248-634-7206
Fax Number	:	248-634-4333

Provider Business Practice Location Address
First Line	:	9080 MILFORD RD
Second Line	:
City	:	HOLLY
State	:	MI
Zip	:	48442-8663
Country	:	US
Telephone Number	:	248-634-7206
Fax Number	:	248-634-4333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/08/2007

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