MEDICARE: TUCKER LEVI WRIGHTS DROT-R/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
1	225X00000X	Occupational Therapist	18589	FL

General Provider Information

NPI Number	:	1336660638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TUCKER LEVI WRIGHTS DROT-R/L

Provider Business Mailing Address
First Line	:	525 NE 7TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3097
Country	:	US
Telephone Number	:	717-729-7422
Fax Number	:

Provider Business Practice Location Address
First Line	:	21065 POWERLINE RD STE 2A
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-2311
Country	:	US
Telephone Number	:	561-883-7800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2017
Last Update Date	:	11/05/2024

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