Provider Demographics
NPI:1073810420
Name:LUCAS, DORIAN (MHS, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:DORIAN
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MHS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WALNUT COURT LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-6100
Mailing Address - Country:US
Mailing Address - Phone:901-355-7808
Mailing Address - Fax:
Practice Address - Street 1:10 WALNUT COURT LN
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-6100
Practice Address - Country:US
Practice Address - Phone:901-355-7808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3136225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist