Healthcare Provider Details

I. General information

NPI: 1194318113
Provider Name (Legal Business Name): TERI DEYOUNG OTR, ECHM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13318 CHASE ST
CROWN POINT IN
46307-9763
US

IV. Provider business mailing address

13318 CHASE ST
CROWN POINT IN
46307-9763
US

V. Phone/Fax

Practice location:
  • Phone: 219-713-2198
  • Fax:
Mailing address:
  • Phone: 219-713-2198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number31001553A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: