Provider Demographics
NPI:1144691395
Name:CURTIS, TERISSA KAY (COTA/L)
Entity type:Individual
Prefix:MS
First Name:TERISSA
Middle Name:KAY
Last Name:CURTIS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1286 S HIGHWAY W
Mailing Address - Street 2:
Mailing Address - City:ELSBERRY
Mailing Address - State:MO
Mailing Address - Zip Code:63343-4039
Mailing Address - Country:US
Mailing Address - Phone:573-213-9446
Mailing Address - Fax:
Practice Address - Street 1:1286 S HIGHWAY W
Practice Address - Street 2:
Practice Address - City:ELSBERRY
Practice Address - State:MO
Practice Address - Zip Code:63343-4039
Practice Address - Country:US
Practice Address - Phone:573-213-9446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.004154222Q00000X
MO2014034916222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2014034916OtherMISSOURI STATE COTA LICENSE
IL057.004154OtherILLINOIS STATE COTA LICENSE