Provider Demographics
NPI:1124203351
Name:LUCK, ANDREA (OTR)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:LUCK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 COOL ROCK
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2998
Mailing Address - Country:US
Mailing Address - Phone:575-637-9089
Mailing Address - Fax:
Practice Address - Street 1:125 COOL ROCK
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2998
Practice Address - Country:US
Practice Address - Phone:575-637-9089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2162225X00000X
TX109492225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist