Provider Demographics
NPI:1003174616
Name:TERRELL, JUNE (OTR)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:
Last Name:TERRELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 E PHIL ELLENA ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1532
Mailing Address - Country:US
Mailing Address - Phone:215-429-8002
Mailing Address - Fax:267-297-7337
Practice Address - Street 1:719 E PHIL ELLENA ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1532
Practice Address - Country:US
Practice Address - Phone:215-429-8002
Practice Address - Fax:267-297-7337
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010250225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist