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General NPI Number Information
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NPI Number | 1457404576
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Entity Type | Individual
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Provider Name | THERESA A PRESCOTT D.O.
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Gender | Female
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Dates
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Enumeration Date | 01/20/2007
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 333 17TH ST STE Q
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City | VERO BEACH
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State | FL
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Zip | 32960-5686
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Country | US
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Telephone | 772-213-8881
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Fax |
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Provider Business Mailing Address
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Address Line | 333 17TH ST STE Q
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City | VERO BEACH
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State | FL
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Zip | 32960-5686
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Country | US
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Telephone | 772-213-8881
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Fax |
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | OS 009024 L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 25MB07287700
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | OS12864
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | OS12864
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License Number State | FL
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