Provider Demographics
NPI:1235723214
Name:DITSON, THERESA ROSE (OTR/L)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:ROSE
Last Name:DITSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:ROSE
Other - Last Name:HEREDIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1751 BOARDWALK AVE
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-5580
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3850 N US HIGHWAY 89
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-8428
Practice Address - Country:US
Practice Address - Phone:928-771-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology