Individual
KERI LOUISE BRONSON TEAGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, OTR/L
Contact information
Practice address
10113 RENWICK CV, FORT WORTH, TX 76244-8574
(415) 200-9193
Mailing address
10113 RENWICK CV, FORT WORTH, TX 76244-8574
(415) 200-9193
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
10246
CA
Other
Enumeration date
05/02/2010
Last updated
02/10/2014
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