Individual
MRS. KATHY JEANNE TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
C.O.T.A.
Contact information
Practice address
1513 BOULDER WAY, SUN PRAIRIE, WI 53590-1253
(608) 837-6152
Mailing address
520 E. HOLUM STREET, DEFOREST, WI 53532
(608) 842-6500
(608) 837-9484
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
254-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40691700
—
WI
Enumeration date
07/23/2007
Last updated
09/04/2014
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