Provider Demographics
NPI:1568225761
Name:LOUKS, TIM (COTA/L)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:LOUKS
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MO
Mailing Address - Zip Code:65483-1002
Mailing Address - Country:US
Mailing Address - Phone:303-350-0104
Mailing Address - Fax:
Practice Address - Street 1:423 W PINE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MO
Practice Address - Zip Code:65483-1147
Practice Address - Country:US
Practice Address - Phone:417-967-3196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015038144224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant