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General NPI Number Information
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NPI Number | 1265015036
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Entity Type | Individual
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Provider Name | BREANNA C LUCYKANISH
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Gender | Female
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Dates
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Enumeration Date | 04/29/2021
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 2011 SCOTLAND AVE
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City | CHAMBERSBURG
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State | PA
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Zip | 17201-1451
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Country | US
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Telephone | 717-262-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 2202 CRIDERS CHURCH RD
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City | CHAMBERSBURG
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State | PA
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Zip | 17202-8055
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Country | US
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Telephone | 717-635-1134
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OP008525
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License Number State | PA
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