Individual
TICESES TEASLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
780 LYNNHAVEN PKWY, SUITE 400, VIRGINIA BEACH, VA 23452-7332
(757) 452-7579
Mailing address
500 FAIRWAY DR., SUIT 102, DEERFIELD BEACH, FL 33441
(888) 880-9270
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
09/12/2016
Last updated
09/12/2016
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