Provider Demographics
NPI:1548630478
Name:TUCKER, PAULA JEANNETTE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:JEANNETTE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:PAULA
Other - Middle Name:JEANNETTE
Other - Last Name:HARRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:4800 W COMMONWEALTH PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-4861
Mailing Address - Country:US
Mailing Address - Phone:602-733-1973
Mailing Address - Fax:
Practice Address - Street 1:4800 W COMMONWEALTH PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-4861
Practice Address - Country:US
Practice Address - Phone:602-733-1973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2107171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor