Healthcare Provider Details

I. General information

NPI: 1245869916
Provider Name (Legal Business Name): LUCAS KENT MATHEWS OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2020
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6698 PALMS CT
CHATTANOOGA TN
37421-2278
US

IV. Provider business mailing address

648 STRAWHILL RD SE
CLEVELAND TN
37323-9357
US

V. Phone/Fax

Practice location:
  • Phone: 865-803-6988
  • Fax:
Mailing address:
  • Phone: 865-803-6988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT009899
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4848
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: