Basic Information
| Provider Information | |||||||||
| NPI: | 1366950727 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TEDESCHI | ||||||||
| FirstName: | ELENA | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 59 ALFRED DR | ||||||||
| Address2: | |||||||||
| City: | COLCHESTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064151767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609442228 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 1ST AVE N | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 59845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067412992 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2018 | ||||||||
| LastUpdateDate: | 04/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.