Provider Demographics
NPI:1508229162
Name:SEELOW, LUCAS JOSEPH (MS OTR)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:JOSEPH
Last Name:SEELOW
Suffix:
Gender:M
Credentials:MS OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4085 SUMMERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-1290
Mailing Address - Country:US
Mailing Address - Phone:920-410-5853
Mailing Address - Fax:
Practice Address - Street 1:2438 E FOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3227
Practice Address - Country:US
Practice Address - Phone:719-473-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0004538225XP0019X
WI5433-26225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation