Provider Demographics
NPI:1679346910
Name:TUCK, HEATHER (CPED CFOM)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:TUCK
Suffix:
Gender:F
Credentials:CPED CFOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 SALEM RD
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-7304
Mailing Address - Country:US
Mailing Address - Phone:417-619-0109
Mailing Address - Fax:
Practice Address - Street 1:1325 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2212
Practice Address - Country:US
Practice Address - Phone:417-619-0109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist