Provider Demographics
NPI:1629536503
Name:LUKITSH, STEPHANIE LAUREN (OTR/L)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LAUREN
Last Name:LUKITSH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 96TH ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-1851
Mailing Address - Country:US
Mailing Address - Phone:312-636-6722
Mailing Address - Fax:
Practice Address - Street 1:3023 S 84TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-3703
Practice Address - Country:US
Practice Address - Phone:414-607-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-09
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6389225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist