MEDICARE: MICHELLE A. TUCKER, LLC

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	171100000X	Acupuncturist	000375	CT
2	175F00000X	Naturopath	000358	CT

General Provider Information

NPI Number	:	1073755930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHELLE A. TUCKER, LLC

Provider Business Mailing Address
First Line	:	5 WASHINGTON DR
Second Line	:
City	:	GALES FERRY
State	:	CT
Zip	:	06335-1936
Country	:	US
Telephone Number	:	860-941-7689
Fax Number	:	860-381-5078

Provider Business Practice Location Address
First Line	:	5 WASHINGTON DR
Second Line	:
City	:	GALES FERRY
State	:	CT
Zip	:	06335-1936
Country	:	US
Telephone Number	:	860-941-7689
Fax Number	:	860-381-5078

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHELLE A TUCKER
Credential	:	ND, L.AC.
Telephone Number	:	860-941-7689

Provider Enumeration Date	:	03/24/2009
Last Update Date	:	03/24/2009

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