Provider Demographics
NPI:1154748432
Name:TUCK, CHERYL
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:TUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 WEIDNER LN
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-2244
Mailing Address - Country:US
Mailing Address - Phone:937-439-2681
Mailing Address - Fax:
Practice Address - Street 1:1512 S US HIGHWAY 68
Practice Address - Street 2:SUITE J100
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-9198
Practice Address - Country:US
Practice Address - Phone:937-484-1557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.02319224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant