Provider Demographics
NPI:1215594965
Name:LUCAS, BILLIE JO (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:BILLIE
Middle Name:JO
Last Name:LUCAS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2566 GIBSON MILL RD
Mailing Address - Street 2:
Mailing Address - City:ELLERBE
Mailing Address - State:NC
Mailing Address - Zip Code:28338-8593
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:804 S LONG DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-4318
Practice Address - Country:US
Practice Address - Phone:910-997-4493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10424224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant