Basic Information
| Provider Information | |||||||||
| NPI: | 1770954067 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | LUCAS | ||||||||
| FirstName: | JEFFERY | ||||||||
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| Credential: | PHD/ABD, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 CAYMUS RD APT 211 | ||||||||
| Address2: | |||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233207514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522362705 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2501 DOWNING ST SW | ||||||||
| Address2: | |||||||||
| City: | WILSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278934517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522376300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2015 | ||||||||
| LastUpdateDate: | 10/13/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 9985 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 0119006732 | VA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.