Provider Demographics
NPI:1326469347
Name:LUKEN, MICHELLE (BS/MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:LUKEN
Suffix:
Gender:F
Credentials:BS/MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11050 MOUNT BELVEDERE BLVD
Mailing Address - Street 2:OCCUPATIONAL THERAPY CLINIC
Mailing Address - City:FORT DRUM
Mailing Address - State:NY
Mailing Address - Zip Code:13602-5438
Mailing Address - Country:US
Mailing Address - Phone:315-774-6246
Mailing Address - Fax:315-774-6046
Practice Address - Street 1:11050 MOUNT BELVEDERE BLVD
Practice Address - Street 2:OCCUPATIONAL THERAPY CLINIC
Practice Address - City:FORT DRUM
Practice Address - State:NY
Practice Address - Zip Code:13602-5438
Practice Address - Country:US
Practice Address - Phone:315-774-6246
Practice Address - Fax:315-774-6046
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06176225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist