Healthcare Provider Details

I. General information

NPI: 1174991228
Provider Name (Legal Business Name): MEGAN FELISKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2015
Last Update Date: 09/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5025 ANN ARBOR RD LEGACY ASSISTED LIVING
JACKSON MI
49201-8801
US

IV. Provider business mailing address

101 E STATE ST GENESIS REHAB SERVICES
KENNETT SQUARE PA
19348-3109
US

V. Phone/Fax

Practice location:
  • Phone: 517-764-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101004887
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: