Provider Demographics
NPI:1932924693
Name:FITZGERALD, TERESA ANN (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:TERESA
Middle Name:ANN
Last Name:FITZGERALD
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 1:118 SOUTHEAST DR
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19526-8339
Mailing Address - Country:US
Mailing Address - Phone:484-818-0739
Mailing Address - Fax:
Practice Address - Street 1:118 SOUTHEAST DR
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:PA
Practice Address - Zip Code:19526-8339
Practice Address - Country:US
Practice Address - Phone:484-818-0739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC003871L225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty