Provider Demographics
NPI:1588138481
Name:LUCAS, TAYLOR (COTA)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-2911
Mailing Address - Country:US
Mailing Address - Phone:304-242-6722
Mailing Address - Fax:304-242-6822
Practice Address - Street 1:1007 MARKET ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-2911
Practice Address - Country:US
Practice Address - Phone:304-242-6722
Practice Address - Fax:304-242-6822
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC2092224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant