Provider Demographics
NPI:1093173411
Name:TUCKER, TIA (RRT)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:
Other - Last Name:MCPIKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT
Mailing Address - Street 1:3504 WESTWIND DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-3203
Mailing Address - Country:US
Mailing Address - Phone:573-881-7974
Mailing Address - Fax:
Practice Address - Street 1:3504 WESTWIND DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-3203
Practice Address - Country:US
Practice Address - Phone:573-881-7974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060270632279E1000X, 2279H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279E1000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredEducational
No2279H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredHome Health