Provider Demographics
| NPI: | 1841685161 |
|---|---|
| Name: | WILLING-TUCKER, DEBRA MARIE (OTRL) |
| Entity type: | Individual |
| Prefix: | MRS |
| First Name: | DEBRA |
| Middle Name: | MARIE |
| Last Name: | WILLING-TUCKER |
| Suffix: | |
| Gender: | F |
| Credentials: | OTRL |
| Other - Prefix: | |
| Other - First Name: | |
| Other - Middle Name: | |
| Other - Last Name: | |
| Other - Suffix: | |
| Other - Last Name Type: | |
| Other - Credentials: | |
| Mailing Address - Street 1: | 4284 W FOUR LAKES DR |
| Mailing Address - Street 2: | |
| Mailing Address - City: | LINDEN |
| Mailing Address - State: | MI |
| Mailing Address - Zip Code: | 48451-8427 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 810-287-7438 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 4284 W FOUR LAKES DR |
| Practice Address - Street 2: | |
| Practice Address - City: | LINDEN |
| Practice Address - State: | MI |
| Practice Address - Zip Code: | 48451-8427 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 810-287-7438 |
| Practice Address - Fax: | |
| Is Sole Proprietor?: | Yes |
| Enumeration Date: | 2015-04-02 |
| Last Update Date: | 2015-04-02 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| MI | 5201002229 | 225X00000X, 225XE0001X, 225XF0002X, 225XM0800X, 225XN1300X, 225XP0019X, 225XP0200X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | |
| No | 225XE0001X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Environmental Modification |
| No | 225XF0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Feeding, Eating & Swallowing |
| No | 225XM0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Mental Health |
| No | 225XN1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Neurorehabilitation |
| No | 225XP0019X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation |
| No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
