Provider Demographics
NPI:1184501645
Name:FRECKLETON, TERESA
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:FRECKLETON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23455 SW PLAMBECK TER APT 415
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-7658
Mailing Address - Country:US
Mailing Address - Phone:423-793-1620
Mailing Address - Fax:
Practice Address - Street 1:19355 SW MOHAVE CT STE 100
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8631
Practice Address - Country:US
Practice Address - Phone:503-486-5199
Practice Address - Fax:503-486-5190
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28827225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist