Provider Demographics
NPI:1174827000
Name:TUCKER, KATHERINE S (MT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:S
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-1053
Mailing Address - Country:US
Mailing Address - Phone:860-287-0994
Mailing Address - Fax:
Practice Address - Street 1:132 RIVER RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-1053
Practice Address - Country:US
Practice Address - Phone:860-287-0994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003561225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist