Provider Demographics
NPI:1104149079
Name:LOCKE, TARALEA JEAN (LMT)
Entity type:Individual
Prefix:MRS
First Name:TARALEA
Middle Name:JEAN
Last Name:LOCKE
Suffix:
Gender:
Credentials:LMT
Other - Prefix:MS
Other - First Name:TARALEA
Other - Middle Name:JEAN
Other - Last Name:LOCKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:9650 SE 250TH AVE
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:OR
Mailing Address - Zip Code:97089-6561
Mailing Address - Country:US
Mailing Address - Phone:971-434-9696
Mailing Address - Fax:
Practice Address - Street 1:4253 SE 182ND AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5083
Practice Address - Country:US
Practice Address - Phone:503-661-5090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15486225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist