MEDICARE: SUSAN FEIGHERY MS, TRS

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	225800000X	Recreation Therapist

General Provider Information

NPI Number	:	1548366586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN FEIGHERY MS, TRS

Provider Business Mailing Address
First Line	:	3347 DAYTON HERZOG LN
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95206-5729
Country	:	US
Telephone Number	:	650-493-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3347 DAYTON HERZOG LN
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95206-5729
Country	:	US
Telephone Number	:	650-493-5000
Fax Number	:

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	07/08/2007

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