Provider Demographics
NPI:1538688593
Name:VITEK, TERESA CAROL (OTR/L)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:CAROL
Last Name:VITEK
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 1:8 DURNESS CT
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-3314
Mailing Address - Country:US
Mailing Address - Phone:410-601-2256
Mailing Address - Fax:410-601-2928
Practice Address - Street 1:2434 W BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5267
Practice Address - Country:US
Practice Address - Phone:410-601-2256
Practice Address - Fax:410-601-2928
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01494225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist