Provider Demographics
NPI:1770031908
Name:TEETSEL, CAROLYN
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:TEETSEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 SR 3009
Mailing Address - Street 2:
Mailing Address - City:MESHOPPEN
Mailing Address - State:PA
Mailing Address - Zip Code:18630
Mailing Address - Country:US
Mailing Address - Phone:570-396-4792
Mailing Address - Fax:
Practice Address - Street 1:4104 VESTAL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3500
Practice Address - Country:US
Practice Address - Phone:607-235-3980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist