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General NPI Number Information
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NPI Number | 1043920275
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Entity Type | Organization
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Legal Business Name | TUCKER ENRICHMENT ACADEMY LLC
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 326 SUTTON RD SE STE H
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City | OWENS CROSS ROADS
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State | AL
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Zip | 35763-9371
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Country | US
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Telephone | 205-886-1901
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Fax |
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Provider Business Mailing Address
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Address Line | 6585 HIGHWAY 431 S STE 245
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City | HAMPTON COVE
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State | AL
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Zip | 35763-9230
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Country | US
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Telephone | 205-886-1901
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Fax |
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Authorized Official
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Title or Position | MBR
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Name | VANESSA TUCKER
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Credential |
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Telephone | 205-886-1901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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