Healthcare Provider Details

I. General information

NPI: 1720661366
Provider Name (Legal Business Name): ANNA LUCAS OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2021
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

852 PERRY RD
APEX NC
27502-7701
US

IV. Provider business mailing address

168 BOXFIELD RD
PITTSBURGH PA
15241-2131
US

V. Phone/Fax

Practice location:
  • Phone: 919-446-5670
  • Fax: 919-267-4761
Mailing address:
  • Phone: 412-527-0823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number14042
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: