Provider Demographics
NPI:1912932401
Name:LUCKETT, KAREN ANN (OTR, CHT, CLCP, CCM)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ANN
Last Name:LUCKETT
Suffix:
Gender:F
Credentials:OTR, CHT, CLCP, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1263 CALLE CERRITO
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-4906
Mailing Address - Country:US
Mailing Address - Phone:805-570-0306
Mailing Address - Fax:805-898-0315
Practice Address - Street 1:1263 CALLE CERRITO
Practice Address - Street 2:SUITE 777
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-4906
Practice Address - Country:US
Practice Address - Phone:805-570-0306
Practice Address - Fax:805-898-0315
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT5460225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1013942507OtherNPI FORMERLY ISSUED
CA056871Medicare Oscar/Certification
CA0722410001Medicare NSC
CA056871Medicare PIN