Provider Demographics
NPI:1699202515
Name:LUCIO, ANTHONY ALLEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:ALLEN
Last Name:LUCIO
Suffix:
Gender:M
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 1:15 SONORA CT
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-1759
Mailing Address - Country:US
Mailing Address - Phone:956-755-9505
Mailing Address - Fax:
Practice Address - Street 1:208 STARR ST STE 2
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-2736
Practice Address - Country:US
Practice Address - Phone:956-514-1551
Practice Address - Fax:956-514-1554
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118402225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist