Basic Information
| Provider Information | |||||||||
| NPI: | 1649631508 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOTSFORD | ||||||||
| FirstName: | TESS | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 MANNING DR | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9849745300 | ||||||||
| FaxNumber: | 9849745305 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 MANNING DR | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9849745300 | ||||||||
| FaxNumber: | 9849745305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2016 | ||||||||
| LastUpdateDate: | 04/30/2018 | ||||||||
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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 | 225X00000X | 10183 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 10183 | 01 | NC | NC LICENSURE | OTHER | 353010 | 01 | NC | NBCOT REGISTRATION | OTHER |