Provider Demographics
NPI:1275966897
Name:DUCKETT, VICTORIA MORGAN (OTA/L)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MORGAN
Last Name:DUCKETT
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 TICK DUCKETT RD
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35951-6629
Mailing Address - Country:US
Mailing Address - Phone:256-302-1569
Mailing Address - Fax:
Practice Address - Street 1:508 BLOUNT AVE
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-1502
Practice Address - Country:US
Practice Address - Phone:256-571-7117
Practice Address - Fax:256-571-7139
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3670225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist