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NPI Code Detail

MEDICARE: LESLIE J LUCAS OTR L

MEDICARE: LESLIE J LUCAS 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
1225X00000XOccupational TherapistOT01249OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OT01249OTHEROHOHIO OT PT ATC BOARD

General Provider Information

NPI Number : 1467442988
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE J LUCAS OTR L
Provider Business Mailing Address
First Line : 533 E MAIN ST
Second Line :
City : RAVENNA
State : OH
Zip : 44266-3218
Country : US
Telephone Number : 330-297-9020
Fax Number : 330-297-9095
Provider Business Practice Location Address
First Line : 2500 BRADY LAKE RD
Second Line :
City : RAVENNA
State : OH
Zip : 44266-1610
Country : US
Telephone Number : 330-678-2400
Fax Number : 330-673-3714
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2005
Last Update Date : 07/08/2007

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Directions to “ LESLIE J LUCAS OTR L” Practice Location

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