Healthcare Provider Details

I. General information

NPI: 1972411999
Provider Name (Legal Business Name): TEQUOAH FREEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 W 15TH ST STE 600
EDMOND OK
73013-3672
US

IV. Provider business mailing address

10613 SW 23RD TER
YUKON OK
73099-2678
US

V. Phone/Fax

Practice location:
  • Phone: 405-562-6072
  • Fax:
Mailing address:
  • Phone: 405-412-6982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: