Healthcare Provider Details

I. General information

NPI: 1043504590
Provider Name (Legal Business Name): THERESE ESQUIVEL MA, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 MAPLE ROW BLVD STE 300
HENDERSONVILLE TN
37075-4487
US

IV. Provider business mailing address

139 MAPLE ROW BLVD STE 300
HENDERSONVILLE TN
37075-4487
US

V. Phone/Fax

Practice location:
  • Phone: 615-826-7113
  • Fax:
Mailing address:
  • Phone: 615-826-7113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6225
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: