Provider Demographics
NPI:1700079332
Name:HENRY, THERESE ANN (OT)
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:ANN
Last Name:HENRY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:THERESE
Other - Middle Name:ANN
Other - Last Name:DEMECHKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:321 PARK HILL DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3375
Mailing Address - Country:US
Mailing Address - Phone:540-446-2654
Mailing Address - Fax:540-656-2755
Practice Address - Street 1:321 PARK HILL DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3375
Practice Address - Country:US
Practice Address - Phone:540-446-2654
Practice Address - Fax:540-656-2755
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4861700-4201225X00000X
VA0119006065225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist