MEDICARE: KIMBERLY LUKECART OTR/L

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	225X00000X	Occupational Therapist	056.007145	IL

General Provider Information

NPI Number	:	1154459824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY LUKECART OTR/L

Provider Business Mailing Address
First Line	:	1830 N MILWAUKEE AVE, #202
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647
Country	:	US
Telephone Number	:	773-272-2722
Fax Number	:	773-880-1294

Provider Business Practice Location Address
First Line	:	1830 N MILWAUKEE AVE, #202
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647
Country	:	US
Telephone Number	:	773-272-2722
Fax Number	:	773-880-1294

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	10/19/2012

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