Basic Information
| Provider Information | |||||||||
| NPI: | 1427106194 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TUCKER | ||||||||
| FirstName: | STACY | ||||||||
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| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1206 HOBSON AVE | ||||||||
| Address2: | |||||||||
| City: | TALLADEGA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351601448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563625599 | ||||||||
| FaxNumber: | 2568322004 | ||||||||
| Practice Location | |||||||||
| Address1: | 2300 COLEMAN RD | ||||||||
| Address2: | |||||||||
| City: | ANNISTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 362076824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568315730 | ||||||||
| FaxNumber: | 2568322004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 1163 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.