MEDICARE: LISA LUCARELLI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	46TR00073100	NJ

General Provider Information

NPI Number	:	1427889286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA LUCARELLI

Provider Business Mailing Address
First Line	:	19 SAWGRASS ST
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-4023
Country	:	US
Telephone Number	:	732-299-1138
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 SAWGRASS ST
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-4023
Country	:	US
Telephone Number	:	732-299-1138
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2024
Last Update Date	:	08/12/2024

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Directions to “ LISA LUCARELLI ” Practice Location

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