Provider Demographics
NPI:1154170082
Name:WEST, TESSIE NADINE (OTA)
Entity type:Individual
Prefix:
First Name:TESSIE
Middle Name:NADINE
Last Name:WEST
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3662 SE 134TH ST # SAT
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-5636
Mailing Address - Country:US
Mailing Address - Phone:352-239-1563
Mailing Address - Fax:
Practice Address - Street 1:3662 SE 134TH ST # SAT
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-5636
Practice Address - Country:US
Practice Address - Phone:352-239-1563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11109224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant