Provider Demographics
NPI:1972309227
Name:EMERGING KIDS PEDIATRIC OCCUPATIONAL THERAPY
Entity type:Organization
Organization Name:EMERGING KIDS PEDIATRIC OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CODY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUKASIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-923-4198
Mailing Address - Street 1:396 WASHINGTON ST STE 227
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-6209
Mailing Address - Country:US
Mailing Address - Phone:781-514-5673
Mailing Address - Fax:
Practice Address - Street 1:494 BOSTON POST RD APT C122
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-1877
Practice Address - Country:US
Practice Address - Phone:781-514-5673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty