Provider Demographics
NPI:1528739208
Name:TERESCO, MELISSA MARGUERITE (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARGUERITE
Last Name:TERESCO
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-3102
Mailing Address - Country:US
Mailing Address - Phone:973-464-7405
Mailing Address - Fax:
Practice Address - Street 1:24 LINDSLEY DRIVE
Practice Address - Street 2:UNIT 207
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960
Practice Address - Country:US
Practice Address - Phone:973-971-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00732300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist