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NPI Code Detail

MEDICARE: STEPHANIE LAUREN LUKITSH OTR/L

MEDICARE: STEPHANIE LAUREN LUKITSH OTR/L
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
1225X00000XOccupational Therapist6389WI

General Provider Information

NPI Number : 1629536503
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE LAUREN LUKITSH OTR/L
Provider Business Mailing Address
First Line : 1680 96TH ST UNIT 1
Second Line :
City : STURTEVANT
State : WI
Zip : 53177-1851
Country : US
Telephone Number : 312-636-6722
Fax Number :
Provider Business Practice Location Address
First Line : 3023 S 84TH ST
Second Line :
City : WEST ALLIS
State : WI
Zip : 53227-3703
Country : US
Telephone Number : 414-607-4100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2019
Last Update Date : 03/09/2019

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