Provider Demographics
NPI:1588131148
Name:JENKINS, TERESA MARIE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:MARIE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 EADS BLUFF RD NW
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37336-4940
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1850 EXECUTIVE PARK NW STE A
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-2700
Practice Address - Country:US
Practice Address - Phone:423-473-8886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOTA2142224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant