Provider Demographics
NPI:1326346222
Name:LUCKE, LISA (OTR)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LUCKE
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 1:4189 HAMPSHIRE PL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4805
Mailing Address - Country:US
Mailing Address - Phone:719-576-1692
Mailing Address - Fax:
Practice Address - Street 1:4189 HAMPSHIRE PL
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4805
Practice Address - Country:US
Practice Address - Phone:719-576-1692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist