Provider Demographics
NPI:1245639293
Name:LUCAS, AMANDA R (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 SHANAHAN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-9078
Mailing Address - Country:US
Mailing Address - Phone:740-657-4050
Mailing Address - Fax:740-657-4099
Practice Address - Street 1:814 SHANAHAN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-9078
Practice Address - Country:US
Practice Address - Phone:740-657-4050
Practice Address - Fax:740-657-4099
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH007980225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics