Provider Demographics
NPI:1033506407
Name:TEERLINCK, JUSTIN (MOT/R/L)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:TEERLINCK
Suffix:
Gender:M
Credentials:MOT/R/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11304 SE 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2328
Mailing Address - Country:US
Mailing Address - Phone:971-732-6958
Mailing Address - Fax:
Practice Address - Street 1:11304 SE 64TH AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-2328
Practice Address - Country:US
Practice Address - Phone:971-732-6958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR334721225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist