Individual
KELLI TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2100 38TH ST NW, CANTON, OH 44709-2312
(330) 492-8136
Mailing address
140 SUPERIOR ST NE, BREWSTER, OH 44613-1136
(330) 437-7847
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA006820
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTA006820
LICENSE-COTA
OH
Enumeration date
08/24/2017
Last updated
08/24/2017
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