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1497068209 NPI number — ALEXIS LILLIE LUCAS MS, OTR/L

NPI Number: 1497068209
Health Care Provider/Practitioner: ALEXIS LILLIE LUCAS MS, OTR/L

Information about “1497068209” NPI (ALEXIS LILLIE LUCAS MS, OTR/L) exists in 1497068209 in HTML format HTML  |  1497068209 in plain Text format TXT  |  1497068209 in PDF (Portable Document Format) PDF  |  1497068209 in an XML format XML  formats.

NPI Number : 1497068209 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1497068209",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LUCAS",
    "FirstName": "ALEXIS",
    "MiddleName": "LILLIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MS, OTR/L",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MCNEIL",
    "OtherFirstName": "ALEXIS",
    "OtherMiddleName": "LILLIE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MS, OTR/L",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1130 FALLS RIVER AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RALEIGH",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27614-7772",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "919-803-2912",
    "MailingAddressFaxNumber": "919-803-3027",
    "FirstLinePracticeLocationAddress": "4560 PRINCESS ANNE RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "VIRGINIA BEACH",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "23462-7905",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "757-474-1249",
    "PracticeLocationAddressFaxNumber": "757-474-0193",
    "EnumerationDate": "07/21/2010",
    "LastUpdateDate": "12/23/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225X00000X",
        "TaxonomyName": "Occupational Therapist",
        "LicenseNumber": "7381",
        "LicenseNumberStateCode": "NC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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