Provider Demographics
NPI:1134479330
Name:LUCE, BERNADETTE T (OTR)
Entity type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:T
Last Name:LUCE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:MARIE
Other - Middle Name:BERNADETTE
Other - Last Name:TASSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 SPARTINA POINT DR
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-1077
Mailing Address - Country:US
Mailing Address - Phone:478-318-9746
Mailing Address - Fax:
Practice Address - Street 1:30 SPARTINA POINT DR
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-1077
Practice Address - Country:US
Practice Address - Phone:478-318-9746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3955225X00000X
GAOT000261225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist