MEDICARE: MS. SUSAN M TUCKER OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	2003024186	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558394429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN M TUCKER OT

Provider Business Mailing Address
First Line	:	PO BOX 7412011
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-2011
Country	:	US
Telephone Number	:	314-286-1669
Fax Number	:	314-627-7219

Provider Business Practice Location Address
First Line	:	5200 BERTHOLD AVE
Second Line	:	DEPT OCCUPATIONAL THERAPY
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1422
Country	:	US
Telephone Number	:	314-286-1669
Fax Number	:	314-627-7219

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	04/17/2025

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