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General NPI Number Information
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NPI Number | 1528503448
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Entity Type | Individual
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Provider Name | JANICE ELAINE DITERESA OTR
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Gender | Female
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Dates
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Enumeration Date | 01/01/2017
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Last Update Date | 10/24/2020
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Provider Practice Location Address
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Address Line | 1025 ROBERT TELFORD DR
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City | RICHMOND
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State | KY
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Zip | 40475-1199
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Country | US
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Telephone | 812-725-4744
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Fax |
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Provider Business Mailing Address
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Address Line | 672 NELLIE BAKER RD
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City | MC KEE
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State | KY
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Zip | 40447-8788
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Country | US
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Telephone | 812-725-4744
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 31000834A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 173881
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License Number State | KY
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