Provider Demographics
NPI:1386289494
Name:VANN, FELICIA (COTA/L)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:VANN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 HUNTING RIDGE RD APT 900
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-4127
Mailing Address - Country:US
Mailing Address - Phone:434-594-0228
Mailing Address - Fax:
Practice Address - Street 1:135 HUNTING RIDGE RD APT 900
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4127
Practice Address - Country:US
Practice Address - Phone:434-594-0228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8810171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
12345OtherOCCUPATIONAL THERAPY