Provider Demographics
NPI:1962086256
Name:GACOVSKY, TESSA JEAN (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:JEAN
Last Name:GACOVSKY
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 TWO HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-2675
Mailing Address - Country:US
Mailing Address - Phone:984-849-3597
Mailing Address - Fax:
Practice Address - Street 1:110 TWO HILLS DR
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-2675
Practice Address - Country:US
Practice Address - Phone:984-849-3597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X, 225XP0200X
NC13980225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics