Provider Demographics
NPI:1992031835
Name:LUCK, TAMARA RACHELLE (LIC MASSAGE THERAPI)
Entity type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:RACHELLE
Last Name:LUCK
Suffix:
Gender:F
Credentials:LIC MASSAGE THERAPI
Other - Prefix:MS
Other - First Name:TAMARA
Other - Middle Name:RACHELLE
Other - Last Name:LUCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NAIL TECHNICIAN
Mailing Address - Street 1:303 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MO
Mailing Address - Zip Code:63537-1543
Mailing Address - Country:US
Mailing Address - Phone:660-342-4244
Mailing Address - Fax:
Practice Address - Street 1:303 S EAST ST
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MO
Practice Address - Zip Code:63537-1543
Practice Address - Country:US
Practice Address - Phone:660-342-4244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009007249225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist