Provider Demographics
NPI:1255499901
Name:TUCKER, ALEXIS (OTR-L, CHT)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:OTR-L, CHT
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:MEGOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR-L
Mailing Address - Street 1:4626 WILLOW ROAD
Mailing Address - Street 2:200
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8547
Mailing Address - Country:US
Mailing Address - Phone:925-463-0470
Mailing Address - Fax:925-463-0473
Practice Address - Street 1:4626 WILLOW ROAD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8547
Practice Address - Country:US
Practice Address - Phone:925-463-0470
Practice Address - Fax:925-463-0473
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15159225XH1200X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
021268T99Medicare Oscar/Certification