MEDICARE: FELITA CHERYL COUNTESS

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	174400000X	Specialist	103977	MD
2	1744P3200X	Prosthetics Case Management	103977	MD
3	335E00000X	Prosthetic/Orthotic Supplier	103977	MD
4	332B00000X	Durable Medical Equipment & Medical Supplies	103977	MD

General Provider Information

NPI Number	:	1679341036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELITA CHERYL COUNTESS

Provider Business Mailing Address
First Line	:	QUIET HOURS PL. 6561 T1
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045
Country	:	US
Telephone Number	:	443-538-5502
Fax Number	:

Provider Business Practice Location Address
First Line	:	6561 T1 QUIET HOURS PL.
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045
Country	:	US
Telephone Number	:	443-538-5502
Fax Number	:

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

Provider Enumeration Date	:	12/15/2023
Last Update Date	:	03/12/2024

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Directions to “ FELITA CHERYL COUNTESS ” Practice Location

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