Provider Demographics
NPI:1609912641
Name:LUXA, ADELE ANGELINE (OTR)
Entity Type:Individual
Prefix:
First Name:ADELE
Middle Name:ANGELINE
Last Name:LUXA
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 1:1881 DEL ROBLES DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-6428
Mailing Address - Country:US
Mailing Address - Phone:727-536-4621
Mailing Address - Fax:
Practice Address - Street 1:801 6TH ST S
Practice Address - Street 2:BOX 7705
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4816
Practice Address - Country:US
Practice Address - Phone:727-767-8087
Practice Address - Fax:727-767-4004
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT1026225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics