Provider Demographics
NPI:1164537221
Name:GAUGHAN, LUKE (OT)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:GAUGHAN
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10785 W TWAIN AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-3026
Mailing Address - Country:US
Mailing Address - Phone:725-726-7847
Mailing Address - Fax:
Practice Address - Street 1:4000 S EASTERN AVE STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-0840
Practice Address - Country:US
Practice Address - Phone:725-726-7847
Practice Address - Fax:725-726-7876
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0295OtherLICENSE #