Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 31003236A | IN |
NPI | 1326672262 |
---|---|
Provider Name | Ronnae Tessely |
First Address | South Bend, IN 46614-5944 |
Second Address | South Bend, IN 46619-2312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2020 |
Last Update Date | 01/03/2020 |