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General NPI Number Information
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NPI Number | 1205644325
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Entity Type | Individual
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Provider Name | ABIGAIL R TUCKER RBT
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Gender | Female
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Dates
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Enumeration Date | 12/20/2024
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 161 PONTIAC BUSINESS CENTER DR
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City | ELGIN
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State | SC
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Zip | 29045-7123
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Country | US
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Telephone | 803-602-2246
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Fax |
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Provider Business Mailing Address
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Address Line | 457 TRUESDALE RD
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City | CAMDEN
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State | SC
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Zip | 29020-8926
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Country | US
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Telephone | 803-602-2246
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 24-344387
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License Number State | SC
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