Provider Demographics
NPI:1568500072
Name:TUCKER, AMY C COLLINS (OTRL)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:C COLLINS
Last Name:TUCKER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:CHRISTINE
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:11549 SUTHERLAND DR
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:KY
Mailing Address - Zip Code:41094
Mailing Address - Country:US
Mailing Address - Phone:859-485-1121
Mailing Address - Fax:859-485-1121
Practice Address - Street 1:11549 SUTHERLAND DR
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:KY
Practice Address - Zip Code:41094-7412
Practice Address - Country:US
Practice Address - Phone:859-485-1121
Practice Address - Fax:859-485-1121
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR1561225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist