Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 1812 | NH |
NPI | 1457695348 |
---|---|
Provider Name | Angela J Tucker |
First Address | Rindge, NH 03461-5838 |
Second Address | Rindge, NH 03461 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2012 |
Last Update Date | 07/03/2016 |