Provider Demographics
NPI:1487085015
Name:WARD, TERRY
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:WARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CLARENCE
Other - Middle Name:HAROLD
Other - Last Name:WARD
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1403 ALBAN AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-5701
Mailing Address - Country:US
Mailing Address - Phone:850-322-6990
Mailing Address - Fax:850-270-6724
Practice Address - Street 1:1403 ALBAN AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-5701
Practice Address - Country:US
Practice Address - Phone:850-322-6990
Practice Address - Fax:850-270-6724
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-08
Last Update Date:2013-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNONE225CA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686873898Medicaid
FL686873896Medicaid
FL686873879Medicaid