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Individual
CERISSE TUCKER
Active
Individual
CERISSE TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
09429
OH
302R00000X
Health Maintenance Organization
09429
OH
3140N1450X
Pediatric Skilled Nursing Facility
Primary
09429
OH
Other
Enumeration date
03/02/2015
Last updated
03/02/2015
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