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General NPI Number Information
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NPI Number | 1114928181
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Entity Type | Individual
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Provider Name | TERESA L RUDISILL
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Gender | Female
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 01/26/2013
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Provider Practice Location Address
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Address Line | 1020 WOODMAN DR SUITE300
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City | DAYTON
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State | OH
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Zip | 45432-1446
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Country | US
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Telephone | 937-266-6914
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Fax | 937-426-1882
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Provider Business Mailing Address
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Address Line | 2817 TORREY PNES
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City | BEAVERCREEK
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State | OH
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Zip | 45431-8614
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Country | US
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Telephone | 937-266-6914
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Fax | 937-426-1882
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4904
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License Number State | OH
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