Provider Demographics
NPI:1861668378
Name:RODDY, TERESA (OTR)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:
Last Name:RODDY
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 1:405 S SUMMIT ST
Mailing Address - Street 2:UNIT F
Mailing Address - City:CRESCENT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32112-3047
Mailing Address - Country:US
Mailing Address - Phone:386-698-4720
Mailing Address - Fax:386-698-4866
Practice Address - Street 1:405 S SUMMIT ST
Practice Address - Street 2:UNIT F
Practice Address - City:CRESCENT CITY
Practice Address - State:FL
Practice Address - Zip Code:32112-3047
Practice Address - Country:US
Practice Address - Phone:386-698-4720
Practice Address - Fax:386-698-4866
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13097225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist