Provider Demographics
NPI:1568946077
Name:BEDNARZ-VANDER HOFF, TERESA (OTR)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:BEDNARZ-VANDER HOFF
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10595 INGALL HWY
Mailing Address - Street 2:
Mailing Address - City:MORENCI
Mailing Address - State:MI
Mailing Address - Zip Code:49256-9738
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:730 KIMOLE LN
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1463
Practice Address - Country:US
Practice Address - Phone:517-263-6771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201002196225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist