Provider Demographics
NPI:1639629009
Name:TEAGUE O'CONNOR, THERESA NICHOLE (MA, CCSH, RPSGT, RST)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:NICHOLE
Last Name:TEAGUE O'CONNOR
Suffix:
Gender:F
Credentials:MA, CCSH, RPSGT, RST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13498 POND SPRINGS RD STE 3
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-4422
Mailing Address - Country:US
Mailing Address - Phone:737-707-4879
Mailing Address - Fax:512-957-8707
Practice Address - Street 1:13498 POND SPRINGS RD STE 3
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-4422
Practice Address - Country:US
Practice Address - Phone:737-707-4879
Practice Address - Fax:512-957-8707
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEG