Individual
DIANNE M TENNANT RUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTRL
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
DM58211298P
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001032002
BLUE CROSS BLUE SHEILD
IL
05
—
371389210
—
IL
01
—
DM58211298P
IL OT LICNESE NUMBER
IL
Enumeration date
01/22/2007
Last updated
07/09/2007
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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