Provider Demographics
NPI:1265933501
Name:TUCKER, TAMARA LYNN (COTA/L)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYNN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 EAGLES RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-4134
Mailing Address - Country:US
Mailing Address - Phone:850-320-3311
Mailing Address - Fax:
Practice Address - Street 1:1331 E LAFAYETTE ST STE F
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-4767
Practice Address - Country:US
Practice Address - Phone:850-354-8682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA13825224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant