Provider Demographics
NPI:1851721112
Name:LUKE, KIRSTIN
Entity Type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:
Last Name:LUKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:KIRSTIN
Other - Last Name:LUKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:88 SECRET HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-1284
Mailing Address - Country:US
Mailing Address - Phone:203-268-0198
Mailing Address - Fax:
Practice Address - Street 1:88 SECRET HOLLOW RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-1284
Practice Address - Country:US
Practice Address - Phone:203-268-0198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1451224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant