Provider Demographics
NPI:1821194481
Name:LUCK, GINA (MOTR/L)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:LUCK
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2241
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-2241
Mailing Address - Country:US
Mailing Address - Phone:505-550-1428
Mailing Address - Fax:
Practice Address - Street 1:708 LAGOON DRIVE
Practice Address - Street 2:UNIT C
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-2241
Practice Address - Country:US
Practice Address - Phone:505-550-1428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing