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NPI Code Detail

MEDICARE: TERESA BARKER MT

MEDICARE:   TERESA  BARKER  MT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1124298724
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA BARKER MT
Provider Business Mailing Address
First Line : 4803 SE WOODSTOCK BLVD
Second Line : #275
City : PORTLAND
State : OR
Zip : 97206-6160
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5120 SE 118TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97266-3250
Country : US
Telephone Number : 503-762-3435
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2008
Last Update Date : 03/10/2008

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Directions to “ TERESA BARKER MT” Practice Location

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