Provider Demographics
NPI:1730062803
Name:RODERIQUES, TERESA CECELIA (OTD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:CECELIA
Last Name:RODERIQUES
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 ROCKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-1360
Mailing Address - Country:US
Mailing Address - Phone:508-542-2967
Mailing Address - Fax:
Practice Address - Street 1:301 ROCKDALE AVE
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-1360
Practice Address - Country:US
Practice Address - Phone:508-542-2967
Practice Address - Fax:508-542-2967
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAOTL-3393225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics