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General NPI Number Information
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NPI Number | 1225857089
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Entity Type | Individual
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Provider Name | JAMIE BROOKS TUCKER OTL/R
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Gender | Female
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 300 W OTTLEY AVE
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City | FRUITA
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State | CO
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Zip | 81521-2118
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Country | US
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Telephone | 970-858-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 2215 DRIFTWOOD LN
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City | GRAND JUNCTION
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State | CO
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Zip | 81507-2606
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Country | US
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Telephone | 808-365-6917
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT.0008363
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License Number State | CO
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