Provider Demographics
NPI:1003974296
Name:TERI INC.
Entity type:Organization
Organization Name:TERI INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:KILMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-721-1706
Mailing Address - Street 1:251 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-1201
Mailing Address - Country:US
Mailing Address - Phone:760-721-1706
Mailing Address - Fax:760-231-5574
Practice Address - Street 1:9606 TIERRA GRANDE STREET
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126
Practice Address - Country:US
Practice Address - Phone:858-695-9415
Practice Address - Fax:858-695-9412
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TERI INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-04
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP0075690Medicaid
CAPQ 0507OtherSAN DIEGO REGIONAL CENTER