1558377416 NPI number — MRS. TERI J SPEAKMAN OTR L CHT

Table of content: MRS. TERI J SPEAKMAN OTR L CHT (NPI 1558377416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558377416 NPI number — MRS. TERI J SPEAKMAN OTR L CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPEAKMAN
Provider First Name:
TERI
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR L CHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAMPBELL
Provider Other First Name:
TERI
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR L
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558377416
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 LANCASTER AVE
Provider Second Line Business Mailing Address:
#225
Provider Business Mailing Address City Name:
PAOLI
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-651-8282
Provider Business Mailing Address Fax Number:
610-651-8283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 LANCASTER AVE
Provider Second Line Business Practice Location Address:
#225
Provider Business Practice Location Address City Name:
PAOLI
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-651-8282
Provider Business Practice Location Address Fax Number:
610-651-8283
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225XH1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0401979000 . This is a "PERSONAL CHOICE 65" identifier . This identifiers is of the category "OTHER".




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