Provider Demographics
NPI:1720274954
Name:JONES, TERESA BUSAM (OTR)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:BUSAM
Last Name:JONES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:BUSAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:5700 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-8858
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3509 HAWORTH DR
Practice Address - Street 2:SUITE 222
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7238
Practice Address - Country:US
Practice Address - Phone:919-662-8340
Practice Address - Fax:919-832-6405
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6583225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics