Provider Demographics
NPI:1205451986
Name:TEASDALL, ISABELLE (OTR/L)
Entity type:Individual
Prefix:
First Name:ISABELLE
Middle Name:
Last Name:TEASDALL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 BASSETT AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1537
Mailing Address - Country:US
Mailing Address - Phone:336-414-1110
Mailing Address - Fax:
Practice Address - Street 1:3310 TATES CREEK RD APT 105
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-3466
Practice Address - Country:US
Practice Address - Phone:859-268-6891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY263138225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist