Provider Demographics
NPI:1659524957
Name:LUCAS, ANGELA DAWN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DAWN
Last Name:LUCAS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8714 FILSON FIELDS CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-5079
Mailing Address - Country:US
Mailing Address - Phone:502-777-3691
Mailing Address - Fax:502-995-6472
Practice Address - Street 1:8714 FILSON FIELDS CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-5079
Practice Address - Country:US
Practice Address - Phone:502-777-3691
Practice Address - Fax:502-995-6472
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R3166225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist