Provider Demographics
NPI:1508171554
Name:NELSON, TERESA NOEL (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:NOEL
Last Name:NELSON
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 1:1409 GOLDEN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CRESCENT
Mailing Address - State:IA
Mailing Address - Zip Code:51526-3618
Mailing Address - Country:US
Mailing Address - Phone:712-227-0081
Mailing Address - Fax:
Practice Address - Street 1:1600 MCPHERSON AVE
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4858
Practice Address - Country:US
Practice Address - Phone:712-322-9285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-15
Last Update Date:2010-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00872225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist