Provider Demographics
NPI:1457639247
Name:O'TOOLE, TEAGAN F (PA-C)
Entity Type:Individual
Prefix:
First Name:TEAGAN
Middle Name:F
Last Name:O'TOOLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TEAGAN
Other - Middle Name:F
Other - Last Name:O'TOOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:245 JEFFERSON ST APT B
Mailing Address - Street 2:
Mailing Address - City:WALDOBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04572-6011
Mailing Address - Country:US
Mailing Address - Phone:207-949-6992
Mailing Address - Fax:
Practice Address - Street 1:22 WHITE ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2978
Practice Address - Country:US
Practice Address - Phone:207-301-6022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1294363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant