Healthcare Provider Details

I. General information

NPI: 1306875943
Provider Name (Legal Business Name): TERRI EISEL OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2959 CANFIELD RD
YOUNGSTOWN OH
44511-2800
US

IV. Provider business mailing address

200 E CALIFORNIA AVE
BOARDMAN OH
44512-5658
US

V. Phone/Fax

Practice location:
  • Phone: 330-799-6298
  • Fax: 330-799-4867
Mailing address:
  • Phone: 330-965-9330
  • Fax: 330-965-9308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT002823
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: