Provider Demographics
NPI:1598895369
Name:TUCKER, DONA C (OTR/L CHT)
Entity Type:Individual
Prefix:MRS
First Name:DONA
Middle Name:C
Last Name:TUCKER
Suffix:
Gender:F
Credentials:OTR/L CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20151 VALHALLA SQ
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4105
Mailing Address - Country:US
Mailing Address - Phone:303-503-6683
Mailing Address - Fax:571-284-7906
Practice Address - Street 1:10560 MAIN ST STE 417
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-717-5667
Practice Address - Fax:703-754-4435
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2368225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
017201OtherKAISER-COMMERCIAL NUMBER
CO29750237Medicaid