Provider Demographics
NPI:1821779331
Name:GREAVES, LUCAS (OT)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:GREAVES
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 RTE 51 N
Mailing Address - Street 2:
Mailing Address - City:ROSTRAVER TWP
Mailing Address - State:PA
Mailing Address - Zip Code:15012
Mailing Address - Country:US
Mailing Address - Phone:724-565-5806
Mailing Address - Fax:724-483-0290
Practice Address - Street 1:265 ELM DR
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-8275
Practice Address - Country:US
Practice Address - Phone:724-852-2504
Practice Address - Fax:724-852-2547
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC019238225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist