Provider Demographics
NPI:1457695348
Name:TUCKER, ANGELA J (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:J
Last Name:TUCKER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SOUTHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-4029
Mailing Address - Country:US
Mailing Address - Phone:978-223-1278
Mailing Address - Fax:
Practice Address - Street 1:21 HUBBARD HILL RD
Practice Address - Street 2:
Practice Address - City:RINDGE
Practice Address - State:NH
Practice Address - Zip Code:03461
Practice Address - Country:US
Practice Address - Phone:603-762-0921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1812225XG0600X
MA8159175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No175T00000XOther Service ProvidersPeer Specialist