Basic Information
| Provider Information | |||||||||
| NPI: | 1558377416 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPEAKMAN | ||||||||
| FirstName: | TERI | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OTR L CHT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CAMPBELL | ||||||||
| OtherFirstName: | TERI | ||||||||
| OtherMiddleName: | J | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | OTR L | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 250 LANCASTER AVE | ||||||||
| Address2: | #225 | ||||||||
| City: | PAOLI | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106518282 | ||||||||
| FaxNumber: | 6106518283 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 LANCASTER AVE | ||||||||
| Address2: | #225 | ||||||||
| City: | PAOLI | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106518282 | ||||||||
| FaxNumber: | 6106518283 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XH1200X | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
| ID | Type | State | Issuer | Description | 0401979000 | 01 | PERSONAL CHOICE 65 | OTHER |