Provider Demographics
NPI:1770647547
Name:TESKE, HEATHER HARRIS (OTD, LOTR)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:HARRIS
Last Name:TESKE
Suffix:
Gender:F
Credentials:OTD, LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 PALMER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-6323
Mailing Address - Country:US
Mailing Address - Phone:504-723-2502
Mailing Address - Fax:504-264-9418
Practice Address - Street 1:4517 LORINO ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2323
Practice Address - Country:US
Practice Address - Phone:504-723-2502
Practice Address - Fax:504-264-9418
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ12274225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAH4164OtherBCBSLA PROVIDER #