Tennant Rucker, Dianne M
Tennant Rucker, Dianne M is an sole proprietor health care provider with primary practice located at 905 N Riverview Ln , Mahomet IL 61853-9768. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist, which is considered as her primary health care specialty. Tennant Rucker, Dianne M can be contacted via phone (217) 621-5429.Contact Information
Primary practice address
905 N Riverview Ln
Mahomet IL 61853-9768
Phone: (217) 621-5429
Fax: (866) 267-2080
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist | 225X00000X | DM58211298P | Illinois |
Profile Details
| NPI number | 1316091036 |
|---|---|
| LBN Legal business name | Tennant Rucker, Dianne M |
| Credentials | OTRL |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 22nd, 2007 |
| Last updated | Jul 9th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1316091036 | NPPES |
| Illinois | MEDICAID | 371389210 | |
| Illinois | Other | DM58211298P | |
| Illinois | Other | 0001032002 |
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