Basic Information
Provider Information
NPI: 1033559000
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TESSLER
FirstName: ELLEN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: OTR/L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 116 GLEN WILLOW CT
Address2:  
City: GREER
State: SC
PostalCode: 296502569
CountryCode: US
TelephoneNumber: 8643462222
FaxNumber:  
Practice Location
Address1: 1807A E MAIN ST
Address2:  
City: EASLEY
State: SC
PostalCode: 296403841
CountryCode: US
TelephoneNumber: 8644427482
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/04/2013
LastUpdateDate: 07/04/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X1460SCY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

ID Information
IDTypeStateIssuerDescription
147788112601SCNPIOTHER


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