MEDICARE: HOPE MARIE LUSK MS, 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	225XP0200X	Pediatric Occupational Therapist	12925	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396925939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOPE MARIE LUSK MS, OTR/L

Provider Business Mailing Address
First Line	:	5060 8TH PL
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32966-2801
Country	:	US
Telephone Number	:	772-567-0061
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 40TH AVE STE 1
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-2467
Country	:	US
Telephone Number	:	772-567-0061
Fax Number	:	772-567-0062

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

Provider Enumeration Date	:	11/12/2007
Last Update Date	:	02/06/2017

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