MEDICARE: FELECIA M MARSHALL PA

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	363A00000X	Physician Assistant	5601004559	MI
2	363AM0700X	Medical Physician Assistant	5601004559	MI

General Provider Information

NPI Number	:	1619917556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELECIA M MARSHALL PA

Provider Business Mailing Address
First Line	:	1560 E MAPLE RD
Second Line	:	SUITE 400-CREDENTIALING
City	:	TROY
State	:	MI
Zip	:	48083-1138
Country	:	US
Telephone Number	:	313-745-4600
Fax Number	:	313-745-1063

Provider Business Practice Location Address
First Line	:	261 MACK AVE
Second Line	:	REHABILITATION INSTITUTE OF MI
City	:	DETROIT
State	:	MI
Zip	:	48201-2417
Country	:	US
Telephone Number	:	313-745-4600
Fax Number	:	313-745-1063

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	10/27/2016

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Directions to “ FELECIA M MARSHALL PA” Practice Location

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