Provider Demographics
NPI:1194167353
Name:RHETT-DAVIS, THERESA LORRAINE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:LORRAINE
Last Name:RHETT-DAVIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 INDEPENDENCE BLVD
Mailing Address - Street 2:LAKESIDE BUSINESS PARK
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1094
Mailing Address - Country:US
Mailing Address - Phone:856-210-2777
Mailing Address - Fax:609-228-0678
Practice Address - Street 1:401 INDEPENDENCE BLVD
Practice Address - Street 2:LAKESIDE BUSINESS PARK
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-1094
Practice Address - Country:US
Practice Address - Phone:856-210-2777
Practice Address - Fax:609-228-0678
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00123800225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics