Provider Demographics
NPI:1447472238
Name:ANTOSH, TERI (OTR)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:ANTOSH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:HUNLOCK CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:18621-3811
Mailing Address - Country:US
Mailing Address - Phone:570-542-7931
Mailing Address - Fax:
Practice Address - Street 1:400 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634-3821
Practice Address - Country:US
Practice Address - Phone:570-788-7321
Practice Address - Fax:570-788-7267
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC00007132L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist