Healthcare Provider Details

I. General information

NPI: 1376933101
Provider Name (Legal Business Name): NICOLE LUTHER MA, ATR-BC, LPAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2015
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17021 OLD ORCHARD RD
LEWES DE
19958-4832
US

IV. Provider business mailing address

120 S WHITE CEDAR DR
MILTON DE
19968-9700
US

V. Phone/Fax

Practice location:
  • Phone: 302-703-6332
  • Fax:
Mailing address:
  • Phone: 570-561-3201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberAT-0000002
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: