Provider Demographics
NPI:1932286580
Name:ALLTUCKER, MEGAN (OT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:ALLTUCKER
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 1:1581 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-2204
Mailing Address - Country:US
Mailing Address - Phone:559-897-5270
Mailing Address - Fax:559-897-0920
Practice Address - Street 1:1581 18TH AVE
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631-2204
Practice Address - Country:US
Practice Address - Phone:559-897-5270
Practice Address - Fax:559-897-0920
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT5000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT5000OtherCA. OT LICENSE