Provider Demographics
NPI:1629247333
Name:SLYNGSTAD, THERESA A (OT)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:SLYNGSTAD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:A
Other - Last Name:LEED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:529 GROSVENOR RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-3341
Mailing Address - Country:US
Mailing Address - Phone:716-250-6500
Mailing Address - Fax:716-250-4177
Practice Address - Street 1:720 EAST AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2192
Practice Address - Country:US
Practice Address - Phone:585-263-2850
Practice Address - Fax:585-263-2885
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP63079225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist