Provider Demographics
NPI:1215379573
Name:TUCKER, MELONIE SHERICE
Entity Type:Individual
Prefix:
First Name:MELONIE
Middle Name:SHERICE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 FLO ZECHMAN DR
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-9103
Mailing Address - Country:US
Mailing Address - Phone:912-572-6135
Mailing Address - Fax:
Practice Address - Street 1:1481 FLO ZECHMAN DR
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-9103
Practice Address - Country:US
Practice Address - Phone:912-572-6135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist