Provider Demographics
NPI:1205887502
Name:JESTER, TERI DENE (PT)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:DENE
Last Name:JESTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:DENE
Other - Last Name:NEW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3727
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-0727
Mailing Address - Country:US
Mailing Address - Phone:877-906-0924
Mailing Address - Fax:
Practice Address - Street 1:3511 CLINTON PL
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-2196
Practice Address - Country:US
Practice Address - Phone:785-331-3783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1700838225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS117007OtherBCBS OF KS
KS26031032OtherBCBS KC
KS117007OtherBCBS OF KS