Healthcare Provider Details

I. General information

NPI: 1851255129
Provider Name (Legal Business Name): LUCAS A LEVERICK OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 PRINCETON AVE
HADDONFIELD NJ
08033-1445
US

IV. Provider business mailing address

805 PRINCETON AVE
HADDONFIELD NJ
08033-1445
US

V. Phone/Fax

Practice location:
  • Phone: 856-834-8921
  • Fax:
Mailing address:
  • Phone: 856-834-8921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR01269300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: