Individual
MISS DAVETTE VENITA RUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Taxonomy
Speciality
Code
Description
License number
State
225XE0001X
Environmental Modification Occupational Therapist
Primary
04134
DC
Other
Enumeration date
01/11/2012
Last updated
01/11/2012
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