Provider Demographics
NPI:1811777139
Name:IOANNUCCI, TERESA MARIE
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:IOANNUCCI
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 1:36 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-3522
Mailing Address - Country:US
Mailing Address - Phone:856-938-7162
Mailing Address - Fax:
Practice Address - Street 1:200 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NJ
Practice Address - Zip Code:07727-3788
Practice Address - Country:US
Practice Address - Phone:215-839-6144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01077500225X00000X
PAOC018792225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist