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NPI Code Detail

MEDICARE: TERI DENE JESTER PT

MEDICARE: TERI DENE JESTER PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist1700838KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1117007OTHERKSBCBS OF KS
226031032OTHERKSBCBS KC

General Provider Information

NPI Number : 1205887502
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERI DENE JESTER PT
Provider Business Mailing Address
First Line : PO BOX 3727
Second Line :
City : LAWRENCE
State : KS
Zip : 66046-0727
Country : US
Telephone Number : 877-906-0924
Fax Number :
Provider Business Practice Location Address
First Line : 3511 CLINTON PL
Second Line :
City : LAWRENCE
State : KS
Zip : 66047-2196
Country : US
Telephone Number : 785-331-3783
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2006
Last Update Date : 07/08/2007

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Directions to “ TERI DENE JESTER PT” Practice Location

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