MEDICARE: LIVE WELL THERAPY SERVICES OT PLLC

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

General Provider Information

NPI Number	:	1851258792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVE WELL THERAPY SERVICES OT PLLC

Provider Business Mailing Address
First Line	:	418 BROADWAY STE N
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12207-2922
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	418 BROADWAY STE N
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12207-2922
Country	:	US
Telephone Number	:	347-622-3172
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MATTHEW TUCKMAN
Credential	:	OTR/L
Telephone Number	:	347-622-3172

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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