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:
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 1:14205 N MOPAC EXPY, STE. 570
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728
Mailing Address - Country:US
Mailing Address - Phone:844-285-2872
Mailing Address - Fax:512-690-0253
Practice Address - Street 1:14205 N MOPAC EXPY, STE. 570
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728
Practice Address - Country:US
Practice Address - Phone:844-285-2872
Practice Address - Fax:512-690-0253
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2025-05-02
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