Provider Demographics
NPI:1154960896
Name:MARTIN, ANNA TUCKER (MSOT, OTR/L)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:TUCKER
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 MEADOW HILL RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-3016
Mailing Address - Country:US
Mailing Address - Phone:502-905-0548
Mailing Address - Fax:
Practice Address - Street 1:1877 FARNSLEY RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4701
Practice Address - Country:US
Practice Address - Phone:502-448-8622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-28
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY165737225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist