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NPI Code Detail

MEDICARE: MRS. KELLY LEIGH AUSTIN TUCK OTR/L

MEDICARE: MRS. KELLY LEIGH AUSTIN TUCK OTR/L
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
1225X00000XOccupational Therapist0119004124VA

General Provider Information

NPI Number : 1215103817
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLY LEIGH AUSTIN TUCK OTR/L
Provider Business Mailing Address
First Line : 2617 PRESTON MILL RD
Second Line :
City : HUDDLESTON
State : VA
Zip : 24104-4113
Country : US
Telephone Number : 540-297-8301
Fax Number :
Provider Business Practice Location Address
First Line : 1317 LOLA AVE
Second Line :
City : ALTAVISTA
State : VA
Zip : 24517-1352
Country : US
Telephone Number : 434-369-6651
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2008
Last Update Date : 05/02/2008

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