Provider Demographics
NPI:1114124757
Name:JONES, THERESA A (OTR L)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:JONES
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 ROWE AVE
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-9700
Mailing Address - Country:US
Mailing Address - Phone:507-372-2232
Mailing Address - Fax:507-372-7326
Practice Address - Street 1:1530 ROWE AVE
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-9700
Practice Address - Country:US
Practice Address - Phone:507-372-2232
Practice Address - Fax:507-372-7326
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100050225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist