Provider Demographics
NPI:1710694427
Name:TUCKER, ABBEY JAYMES (OT)
Entity Type:Individual
Prefix:
First Name:ABBEY
Middle Name:JAYMES
Last Name:TUCKER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12057
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29504-2057
Mailing Address - Country:US
Mailing Address - Phone:843-229-5813
Mailing Address - Fax:843-662-3612
Practice Address - Street 1:1261 CELEBRATION BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5499
Practice Address - Country:US
Practice Address - Phone:843-229-5813
Practice Address - Fax:843-662-3612
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6690225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist