Healthcare Provider Details

I. General information

NPI: 1396794533
Provider Name (Legal Business Name): TERI BRISLIN MA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11665 AVENA PL SUITE 106
SAN DIEGO CA
92128-2421
US

IV. Provider business mailing address

11895 ARBORLAKE WAY
SAN DIEGO CA
92131-2608
US

V. Phone/Fax

Practice location:
  • Phone: 858-673-5437
  • Fax:
Mailing address:
  • Phone: 858-547-0906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 1853
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: