Provider Demographics
NPI:1770844896
Name:REESE, LUCAS MICHAEL (BS)
Entity Type:Individual
Prefix:MR
First Name:LUCAS
Middle Name:MICHAEL
Last Name:REESE
Suffix:
Gender:M
Credentials:BS
Other - Prefix:MR
Other - First Name:LUKE
Other - Middle Name:MICHAEL
Other - Last Name:REESE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:5929 N MAY AVE STE 218
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-3925
Mailing Address - Country:US
Mailing Address - Phone:405-254-5760
Mailing Address - Fax:405-254-5760
Practice Address - Street 1:5929 N MAY AVE STE 218
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3925
Practice Address - Country:US
Practice Address - Phone:405-254-5760
Practice Address - Fax:405-254-5760
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner