Provider Demographics
NPI:1053481481
Name:STEWART, THERESA DALY (OTR)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:DALY
Last Name:STEWART
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:MARIA
Other - Last Name:DALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:2455 LUNETTA LN
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-4213
Mailing Address - Country:US
Mailing Address - Phone:404-583-8405
Mailing Address - Fax:
Practice Address - Street 1:2455 LUNETTA LN
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-4213
Practice Address - Country:US
Practice Address - Phone:404-583-8405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT000843225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist