Individual
TERI ANN HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
250 LAWRENCE AVE, PARK FALLS, WI 54552-1431
(715) 762-2449
Mailing address
N7953 WILSON LAKE RD, PHILLIPS, WI 54555-6740
(715) 339-3221
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1646-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1646-027
OT ASSISTANT
WI
05
—
40877100
—
WI
Enumeration date
05/01/2007
Last updated
07/09/2007
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