Provider Demographics
NPI:1528503448
Name:DITERESA, JANICE ELAINE (OTR)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:ELAINE
Last Name:DITERESA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 NELLIE BAKER RD
Mailing Address - Street 2:
Mailing Address - City:MC KEE
Mailing Address - State:KY
Mailing Address - Zip Code:40447-8788
Mailing Address - Country:US
Mailing Address - Phone:812-725-4744
Mailing Address - Fax:
Practice Address - Street 1:1025 ROBERT TELFORD DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-1199
Practice Address - Country:US
Practice Address - Phone:812-725-4744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-01
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000834A225X00000X
KY173881225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist