Provider Demographics
NPI:1154532026
Name:LUCKENBILL, WENDY MARIE (COTA)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:MARIE
Last Name:LUCKENBILL
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 1:47 SAINT JOSEPHS WAY
Mailing Address - Street 2:
Mailing Address - City:SCHUYLKILL HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17972-9386
Mailing Address - Country:US
Mailing Address - Phone:570-739-4945
Mailing Address - Fax:
Practice Address - Street 1:1000 ORWIGSBURG MANOR DR
Practice Address - Street 2:
Practice Address - City:ORWIGSBURG
Practice Address - State:PA
Practice Address - Zip Code:17961-1303
Practice Address - Country:US
Practice Address - Phone:570-366-2999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP002497L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant