Provider Demographics
NPI:1801808621
Name:PULLIG, TERESA LYNN
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:LYNN
Last Name:PULLIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7028 ESLER FIELD RD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-3798
Mailing Address - Country:US
Mailing Address - Phone:318-640-7958
Mailing Address - Fax:318-640-7958
Practice Address - Street 1:7028 ESLER FIELD RD
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-3798
Practice Address - Country:US
Practice Address - Phone:318-640-7958
Practice Address - Fax:318-640-7958
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ11364225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X850Medicare ID - Type Unspecified