Provider Demographics
NPI:1093970170
Name:UPPFALT, TERRI JANE (OTR)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:JANE
Last Name:UPPFALT
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 1:6196 W MORGAN CT
Mailing Address - Street 2:
Mailing Address - City:NEW PALESTINE
Mailing Address - State:IN
Mailing Address - Zip Code:46163-8762
Mailing Address - Country:US
Mailing Address - Phone:317-861-4448
Mailing Address - Fax:
Practice Address - Street 1:6196 W MORGAN CT
Practice Address - Street 2:
Practice Address - City:NEW PALESTINE
Practice Address - State:IN
Practice Address - Zip Code:46163-8762
Practice Address - Country:US
Practice Address - Phone:317-861-4448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004116A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist