Provider Demographics
NPI:1336626050
Name:WILHELM, TERESA MEGAN (COTA/L)
Entity type:Individual
Prefix:MISS
First Name:TERESA
Middle Name:MEGAN
Last Name:WILHELM
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1389 OAK RIDGE FARM HWY
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-6922
Mailing Address - Country:US
Mailing Address - Phone:704-213-4597
Mailing Address - Fax:
Practice Address - Street 1:363 CHURCH ST N STE 260-E
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4560
Practice Address - Country:US
Practice Address - Phone:704-239-6321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant