Provider Demographics
NPI:1073932166
Name:LUCAS, ASHLEY (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 SHAGBARK DR
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-2637
Mailing Address - Country:US
Mailing Address - Phone:203-257-7801
Mailing Address - Fax:
Practice Address - Street 1:230 SHAGBARK DR
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-2637
Practice Address - Country:US
Practice Address - Phone:203-257-7801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004218174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist