Provider Demographics
NPI:1326507807
Name:TUCHOLKE, TODD (SPT)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:TUCHOLKE
Suffix:
Gender:M
Credentials:SPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2486 MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-1858
Mailing Address - Country:US
Mailing Address - Phone:541-556-2562
Mailing Address - Fax:
Practice Address - Street 1:120 SHELTON MCMURPHEY BLVD STE 300
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8718
Practice Address - Country:US
Practice Address - Phone:458-210-2940
Practice Address - Fax:541-654-4680
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program