Provider Demographics
NPI:1003093899
Name:WOOD, TERRIELLEN (PTA, COTA)
Entity Type:Individual
Prefix:MRS
First Name:TERRIELLEN
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:PTA, COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 MT. HUNGER ROAD
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05048
Mailing Address - Country:US
Mailing Address - Phone:802-436-2847
Mailing Address - Fax:
Practice Address - Street 1:24 OLD ETNA ROAD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766
Practice Address - Country:US
Practice Address - Phone:603-442-4207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0566224Z00000X
VT073-0000184224Z00000X
NH0925225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant