Provider Demographics
NPI:1497068209
Name:LUCAS, ALEXIS LILLIE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:LILLIE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:LILLIE
Other - Last Name:MCNEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:1130 FALLS RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7772
Mailing Address - Country:US
Mailing Address - Phone:919-803-2912
Mailing Address - Fax:919-803-3027
Practice Address - Street 1:4560 PRINCESS ANNE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-7905
Practice Address - Country:US
Practice Address - Phone:757-474-1249
Practice Address - Fax:757-474-0193
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7381225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist