Provider Demographics
NPI:1225800139
Name:LUKITSCH, TARA ANNE (MSOTR/L)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:ANNE
Last Name:LUKITSCH
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5349 ALAN CIR
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-5038
Mailing Address - Country:US
Mailing Address - Phone:484-541-8358
Mailing Address - Fax:
Practice Address - Street 1:5349 ALAN CIR
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-5038
Practice Address - Country:US
Practice Address - Phone:484-541-8358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC017233225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist