Provider Demographics
NPI:1891953105
Name:TUCKER, JOSEPHINE ANN (OTR CHT)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:ANN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:OTR CHT
Other - Prefix:
Other - First Name:JO
Other - Middle Name:
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR CHT
Mailing Address - Street 1:5315 ELLIOTT DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197
Mailing Address - Country:US
Mailing Address - Phone:734-712-0600
Mailing Address - Fax:734-712-0522
Practice Address - Street 1:5315 ELLIOTT DR
Practice Address - Street 2:SUITE 202
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-712-0600
Practice Address - Fax:734-712-0522
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000596225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand