Provider Demographics
NPI:1295950301
Name:TEITELL, LAURA M (OTR)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:TEITELL
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 1:734 CARMET RD
Mailing Address - Street 2:
Mailing Address - City:RYDAL
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3308
Mailing Address - Country:US
Mailing Address - Phone:215-470-9959
Mailing Address - Fax:267-200-0839
Practice Address - Street 1:734 CARMET RD
Practice Address - Street 2:
Practice Address - City:RYDAL
Practice Address - State:PA
Practice Address - Zip Code:19046-3308
Practice Address - Country:US
Practice Address - Phone:215-470-9959
Practice Address - Fax:267-200-0839
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC-000559-L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist