Provider Demographics
NPI:1336660638
Name:WRIGHTS, TUCKER LEVI (DROT-R/L)
Entity Type:Individual
Prefix:
First Name:TUCKER
Middle Name:LEVI
Last Name:WRIGHTS
Suffix:
Gender:M
Credentials:DROT-R/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 SE 2ND AVE APT 715
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1068
Mailing Address - Country:US
Mailing Address - Phone:717-729-7422
Mailing Address - Fax:
Practice Address - Street 1:21065 POWERLINE RD STE 2A
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-2311
Practice Address - Country:US
Practice Address - Phone:561-883-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18589225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist