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General NPI Number Information
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NPI Number | 1801063029
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Entity Type | Individual
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Provider Name | AMBER NICOLE TESMAN RSA
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Gender | Female
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 1801 FOX DR
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City | CHAMPAIGN
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State | IL
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Zip | 61820-7236
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Country | US
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Telephone | 217-398-8080
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Fax |
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Provider Business Mailing Address
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Address Line | 1132 BEL AIRE DR
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City | RANTOUL
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State | IL
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Zip | 61866-1617
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Country | US
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Telephone | 217-892-2798
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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 | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number | T25501487607
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License Number State | IL
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