Provider Demographics
NPI:1124507587
Name:PETERSON-BONEY, TERI LYNN (OTR)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:LYNN
Last Name:PETERSON-BONEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:LYNN
Other - Last Name:BONEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR, OTA
Mailing Address - Street 1:1101 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-3532
Mailing Address - Country:US
Mailing Address - Phone:903-450-6255
Mailing Address - Fax:
Practice Address - Street 1:1501 HOLIDAY DR
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-4707
Practice Address - Country:US
Practice Address - Phone:903-335-8727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206169224Z00000X
TX118234225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant