MEDICARE: MOLLY LUKES 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	OT4633	NM

General Provider Information

NPI Number	:	1568286045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY LUKES OTR/L

Provider Business Mailing Address
First Line	:	1606 ALISO DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-5606
Country	:	US
Telephone Number	:	208-908-2551
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 TAYLOR LOOP
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87508-4509
Country	:	US
Telephone Number	:	505-519-6932
Fax Number	:	505-372-0702

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

Provider Enumeration Date	:	11/12/2024
Last Update Date	:	11/12/2024

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Directions to “ MOLLY LUKES OTR/L” Practice Location

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