# TERESA IRENE PORTER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1447514567
- **Gender:** F
- **Credential:** OTA-01110

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171W00000X | Contractor | OTA 01110 | OH | Yes |

## Other

- **Enumeration date:** 07/03/2012
- **Last updated:** 07/03/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | OTA 01110 | THERAPY | OH |