Provider Demographics
NPI:1477210706
Name:RUTHERFORD, THERESA (OTR/L)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:35 ICE POND RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NH
Mailing Address - Zip Code:03584-4426
Mailing Address - Country:US
Mailing Address - Phone:603-788-4924
Mailing Address - Fax:
Practice Address - Street 1:35 ICE POND RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NH
Practice Address - Zip Code:03584-4426
Practice Address - Country:US
Practice Address - Phone:603-788-4924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0740225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist