Provider Demographics
NPI:1265491211
Name:LUCAS, KAMIE JOY (ATC, LAT)
Entity Type:Individual
Prefix:MS
First Name:KAMIE
Middle Name:JOY
Last Name:LUCAS
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 ARDMORE AVE
Mailing Address - Street 2:APT. 54
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-4824
Mailing Address - Country:US
Mailing Address - Phone:260-557-5400
Mailing Address - Fax:
Practice Address - Street 1:1600 E WASHINGTON BLVD
Practice Address - Street 2:INDIANA INSTITUTE OF TECHNOLOGY
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46803
Practice Address - Country:US
Practice Address - Phone:260-422-5561
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001232A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer