MEDICARE: ANGELI LUCERNAS

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	OT12569	FL

General Provider Information

NPI Number	:	1952422644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELI LUCERNAS

Provider Business Mailing Address
First Line	:	6011 MEDICI CT
Second Line	:	APT 306
City	:	SARASOTA
State	:	FL
Zip	:	34243-2645
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6011 MEDICI CT
Second Line	:	APT 306
City	:	SARASOTA
State	:	FL
Zip	:	34243-2645
Country	:	US
Telephone Number	:	941-524-1427
Fax Number	:

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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