Provider Demographics
NPI:1679191837
Name:EDWARDS, TESSA (MOT, OT)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MOT, OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6896 CHERRY LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2429
Mailing Address - Country:US
Mailing Address - Phone:317-360-2266
Mailing Address - Fax:
Practice Address - Street 1:6330 E 75TH ST STE 206
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2700
Practice Address - Country:US
Practice Address - Phone:317-284-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31007195A225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics