Provider Demographics
NPI:1033875679
Name:VAN METER, TERESA MICHELLE
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MICHELLE
Last Name:VAN METER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 PARADISE CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-6946
Mailing Address - Country:US
Mailing Address - Phone:651-206-2594
Mailing Address - Fax:
Practice Address - Street 1:165 WELLS RD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-3035
Practice Address - Country:US
Practice Address - Phone:904-269-3522
Practice Address - Fax:904-621-9339
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist