Provider Demographics
NPI:1588063358
Name:FEY-HAGGARD, VALENTINA MARIE (ATC, CEIS)
Entity type:Individual
Prefix:MRS
First Name:VALENTINA
Middle Name:MARIE
Last Name:FEY-HAGGARD
Suffix:
Gender:F
Credentials:ATC, CEIS
Other - Prefix:MS
Other - First Name:VALENTINA
Other - Middle Name:MARIE
Other - Last Name:FEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5949 W RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-4348
Mailing Address - Country:US
Mailing Address - Phone:317-908-0040
Mailing Address - Fax:317-486-2194
Practice Address - Street 1:14700 W SCHULTE RD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-8628
Practice Address - Country:US
Practice Address - Phone:317-908-0040
Practice Address - Fax:209-836-8280
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer