Provider Demographics
NPI:1962278036
Name:LUCKY, JOEL (OTRL)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:LUCKY
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 BARKLEY DR
Mailing Address - Street 2:
Mailing Address - City:HICKORY CREEK
Mailing Address - State:TX
Mailing Address - Zip Code:75065-2950
Mailing Address - Country:US
Mailing Address - Phone:469-348-1218
Mailing Address - Fax:
Practice Address - Street 1:1805 RINGTAIL DR
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-8484
Practice Address - Country:US
Practice Address - Phone:940-535-8105
Practice Address - Fax:940-241-4204
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109441225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist