Provider Demographics
NPI:1851437081
Name:TUCKER, MARTHA ANN (OTR)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:ANN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 12TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-5237
Mailing Address - Country:US
Mailing Address - Phone:405-321-4048
Mailing Address - Fax:
Practice Address - Street 1:250 12TH AVE NE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-5237
Practice Address - Country:US
Practice Address - Phone:405-321-4048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109666225XP0200X
OK494225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics