Provider Demographics
NPI:1255620647
Name:BEARDSLEY, TERESA KAY (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:KAY
Last Name:BEARDSLEY
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 1:310 WINDSONG DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-7318
Mailing Address - Country:US
Mailing Address - Phone:912-445-0298
Mailing Address - Fax:
Practice Address - Street 1:310 WINDSONG DR
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-7318
Practice Address - Country:US
Practice Address - Phone:912-445-0298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT000397225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist