Provider Demographics
NPI:1679060180
Name:EVERHART, TERESA ALTONA (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ALTONA
Last Name:EVERHART
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:TESS
Other - Middle Name:
Other - Last Name:EVERHART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTD, OTR/L
Mailing Address - Street 1:514 S 24TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-2544
Mailing Address - Country:US
Mailing Address - Phone:812-249-6213
Mailing Address - Fax:
Practice Address - Street 1:310 BROWNING RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-2608
Practice Address - Country:US
Practice Address - Phone:812-249-6213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5652225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics