Provider Demographics
NPI:1316061732
Name:LETZELTER, THERESA A (OTR-L)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:A
Last Name:LETZELTER
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 1:120 KECK RD
Mailing Address - Street 2:
Mailing Address - City:SARVER
Mailing Address - State:PA
Mailing Address - Zip Code:16055-8511
Mailing Address - Country:US
Mailing Address - Phone:724-352-1571
Mailing Address - Fax:724-352-4685
Practice Address - Street 1:134 MARWOOD RD
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:PA
Practice Address - Zip Code:16023-2206
Practice Address - Country:US
Practice Address - Phone:724-352-1571
Practice Address - Fax:724-352-4685
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC001592L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist