Healthcare Provider Details

I. General information

NPI: 1679209662
Provider Name (Legal Business Name): LIXUE BURNEY VANUCCI OTD, OTR/L, LSVT-BIG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LIXUE MASON OTD, OTR/L

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22502 SAMBAR LOOP
CHUGIAK AK
99567-5377
US

IV. Provider business mailing address

PO BOX 672075
CHUGIAK AK
99567-2075
US

V. Phone/Fax

Practice location:
  • Phone: 907-921-7384
  • Fax: 844-605-1820
Mailing address:
  • Phone: 907-921-7384
  • Fax: 844-605-1820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number180035
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: