Provider Demographics
NPI:1992732408
Name:WEBSTER, TERI B (OTR)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:B
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:B
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:555 W WACKERLY ST STE 3600
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4714
Mailing Address - Country:US
Mailing Address - Phone:989-631-3570
Mailing Address - Fax:
Practice Address - Street 1:555 W WACKERLY ST STE 3600
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4714
Practice Address - Country:US
Practice Address - Phone:989-631-3570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006406225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4956540Medicaid
MIN75070005Medicare PIN