MEDICARE: OTHELLA LUCAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		CO

General Provider Information

NPI Number	:	1073462594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OTHELLA LUCAS

Provider Business Mailing Address
First Line	:	1015 GARDEN OF THE GODS RD STE A
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-3432
Country	:	US
Telephone Number	:	719-354-5297
Fax Number	:	719-960-2712

Provider Business Practice Location Address
First Line	:	1015 GARDEN OF THE GODS RD STE A
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-3432
Country	:	US
Telephone Number	:	719-354-5297
Fax Number	:	719-960-2712

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	01/27/2026

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Directions to “ OTHELLA LUCAS ” Practice Location

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