Provider Demographics
NPI:1730578196
Name:TUCKER, ANNA KATHERINE (COTA)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:KATHERINE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:RICHWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77566
Mailing Address - Country:US
Mailing Address - Phone:979-824-2818
Mailing Address - Fax:
Practice Address - Street 1:1052 CARDINAL DR
Practice Address - Street 2:
Practice Address - City:RICHWOOD
Practice Address - State:TX
Practice Address - Zip Code:77566
Practice Address - Country:US
Practice Address - Phone:979-824-2818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210386224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant