Provider Demographics
NPI:1164095071
Name:TUCKER, RACHAEL GRACE (OTR/L)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:GRACE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 ROCKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HASKELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07420-1037
Mailing Address - Country:US
Mailing Address - Phone:973-358-2853
Mailing Address - Fax:
Practice Address - Street 1:18 ROCKRIDGE RD
Practice Address - Street 2:
Practice Address - City:HASKELL
Practice Address - State:NJ
Practice Address - Zip Code:07420-1037
Practice Address - Country:US
Practice Address - Phone:973-358-2853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00944300225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental HealthGroup - Single Specialty