Provider Demographics
NPI:1497368492
Name:TUCCELLI, DALE A
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:A
Last Name:TUCCELLI
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 1:168 WALTON RD UNIT 58
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03874-4500
Mailing Address - Country:US
Mailing Address - Phone:781-974-7929
Mailing Address - Fax:
Practice Address - Street 1:58 RANGE RD STE R03
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-2026
Practice Address - Country:US
Practice Address - Phone:603-898-0030
Practice Address - Fax:603-894-6343
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7878225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH020468793OtherFED TAX ID