Provider Demographics
NPI:1003179920
Name:SCHLICHENMAYER, LUKE AARON (OTR/L)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:AARON
Last Name:SCHLICHENMAYER
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 1:1518 E BOULEVARD AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4265
Mailing Address - Country:US
Mailing Address - Phone:701-527-8959
Mailing Address - Fax:
Practice Address - Street 1:1051 E INTERSTATE AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0551
Practice Address - Country:US
Practice Address - Phone:701-222-8322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1220225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist