Healthcare Provider Details

I. General information

NPI: 1902218647
Provider Name (Legal Business Name): JOHN FEILER OCCUPATIONAL THERAPI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 JEFFERSON ST.
FAIRFIELD CT
06825
US

IV. Provider business mailing address

175 JEFFERSON ST.
FAIRFIELD CT
06825
US

V. Phone/Fax

Practice location:
  • Phone: 203-365-6443
  • Fax:
Mailing address:
  • Phone: 203-365-6443
  • Fax: 203-396-1046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number002048
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: