Provider Demographics
NPI:1992919245
Name:TEVES, DONALD (OT)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:TEVES
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7516 BOWLANDER WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-9147
Mailing Address - Country:US
Mailing Address - Phone:917-251-3685
Mailing Address - Fax:
Practice Address - Street 1:5980 W 71ST ST
Practice Address - Street 2:SUITE 201
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-2711
Practice Address - Country:US
Practice Address - Phone:317-388-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009996225X00000X
IN31004513A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist