Healthcare Provider Details

I. General information

NPI: 1366565632
Provider Name (Legal Business Name): LUCILLE ANN BARRETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6509 N 3RD ST
PHILADELPHIA PA
19126-3913
US

IV. Provider business mailing address

6509 N 3RD ST
PHILADELPHIA PA
19126-3913
US

V. Phone/Fax

Practice location:
  • Phone: 215-549-6468
  • Fax:
Mailing address:
  • Phone: 215-549-6468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOP001252L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: