Shelly Germaine Teesdale, MSOTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

5201007005 Issued in MI

Practice address

4450 Cascade Rd SE
Grand Rapids, MI 49546-3633

Phone

(616) 949-5140

NPI assigned

Jul 24, 2018

Last updated

Jul 24, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Porter Hills Home Health West

  • Home Health Agency
  • Grand Rapids, MI
  • NPI 1508845066
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1532390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532390400000",
    "number": "1528545415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2063 WINSTON VIEW DR NE",
            "city": "CEDAR SPRINGS",
            "state": "MI",
            "postal_code": "493197947",
            "telephone_number": "616-862-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4450 CASCADE RD SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463633",
            "telephone_number": "616-949-5140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEESDALE",
        "first_name": "SHELLY",
        "middle_name": "GERMAINE",
        "credential": "MSOTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-24",
        "last_updated": "2018-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201007005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chase Teague
• Team Cook Inc (Hand & Stone)
• Suzanne M Tebeest, LMSW
• Maria Elizabeth Tecos, MD
• Emily Lucille Teesdale, A-GNP
• Jenna Teeter, BS
• Kelly S Teft, PA-C
• Morad M Tehrani, MD
• Erin N Teitsma, PA-C
• Larry R Teitsma, PHD

• Occupational Therapist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Occupational Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.