Healthcare Provider Details

I. General information

NPI: 1770647547
Provider Name (Legal Business Name): HEATHER HARRIS TESKE OTD, LOTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4517 LORINO ST
METAIRIE LA
70006-2323
US

IV. Provider business mailing address

2725 PALMER AVE
NEW ORLEANS LA
70118-6323
US

V. Phone/Fax

Practice location:
  • Phone: 504-723-2502
  • Fax: 504-264-9418
Mailing address:
  • Phone: 504-723-2502
  • Fax: 504-264-9418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberZ12274
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: