Provider Demographics
NPI:1962750745
Name:NELSON, LUKE A (OTRL)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:A
Last Name:NELSON
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 1:44738 MORLEY DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-1357
Mailing Address - Country:US
Mailing Address - Phone:586-421-4062
Mailing Address - Fax:586-421-4072
Practice Address - Street 1:44738 MORLEY DR
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036-1357
Practice Address - Country:US
Practice Address - Phone:586-421-4062
Practice Address - Fax:586-421-4072
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202007580224Z00000X
MI5201009899225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant