Provider Demographics
NPI:1881427128
Name:MUSSATTO, TERRI JO
Entity type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:JO
Last Name:MUSSATTO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TERRI
Other - Middle Name:JO
Other - Last Name:KESSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 MILL ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:IL
Mailing Address - Zip Code:62069-2038
Mailing Address - Country:US
Mailing Address - Phone:618-420-1703
Mailing Address - Fax:
Practice Address - Street 1:700 MILL ST
Practice Address - Street 2:
Practice Address - City:MOUNT OLIVE
Practice Address - State:IL
Practice Address - Zip Code:62069-2038
Practice Address - Country:US
Practice Address - Phone:618-420-1703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist