Provider Demographics
NPI:1134332208
Name:DORVAL, TERESA LYNNE
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNNE
Last Name:DORVAL
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 1:1140 TOWNSEND ST
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-2529
Mailing Address - Country:US
Mailing Address - Phone:815-899-9172
Mailing Address - Fax:
Practice Address - Street 1:1140 TOWNSEND ST
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-2529
Practice Address - Country:US
Practice Address - Phone:815-899-9172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist