Provider Demographics
NPI:1962170670
Name:LUKASZEK, JESSICA LYNN (OTR)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LYNN
Last Name:LUKASZEK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07946-1236
Mailing Address - Country:US
Mailing Address - Phone:732-547-7136
Mailing Address - Fax:
Practice Address - Street 1:6 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07946-1236
Practice Address - Country:US
Practice Address - Phone:732-547-7136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01009400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist