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NPI Code Detail

MEDICARE: TERI BRISLIN MA OTR/L

MEDICARE: TERI BRISLIN MA OTR/L
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
1225XP0200XPediatric Occupational TherapistOT 1853CA

General Provider Information

NPI Number : 1396794533
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERI BRISLIN MA OTR/L
Provider Business Mailing Address
First Line : 11895 ARBORLAKE WAY
Second Line :
City : SAN DIEGO
State : CA
Zip : 92131-2608
Country : US
Telephone Number : 858-547-0906
Fax Number :
Provider Business Practice Location Address
First Line : 11665 AVENA PL
Second Line : SUITE 106
City : SAN DIEGO
State : CA
Zip : 92128-2421
Country : US
Telephone Number : 858-673-5437
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2006
Last Update Date : 07/08/2007

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Directions to “ TERI BRISLIN MA OTR/L” Practice Location

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