Provider Demographics
NPI:1306163225
Name:TEAGUE, KERI LOUISE BRONSON (MA, OTR/L)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:LOUISE BRONSON
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10113 RENWICK CV
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-8574
Mailing Address - Country:US
Mailing Address - Phone:415-200-9193
Mailing Address - Fax:
Practice Address - Street 1:10113 RENWICK CV
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-8574
Practice Address - Country:US
Practice Address - Phone:415-200-9193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-02
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10246225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics