Provider Demographics
NPI:1669913604
Name:TOTH, TERESA L
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:TOTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:L
Other - Last Name:COPPIELLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1011 PARSONS LNDG
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-5831
Mailing Address - Country:US
Mailing Address - Phone:734-732-0727
Mailing Address - Fax:
Practice Address - Street 1:6070 AVENIDA ENCINAS
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1001
Practice Address - Country:US
Practice Address - Phone:760-444-0102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17012225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist