Individual
MS. JACQUELINE M LUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR-L
Contact information
Practice address
4515 BRAMBLETON AVE, ROANOKE, VA 24018-3436
(540) 961-1230
(540) 951-0613
Mailing address
4515 BRAMBLETON AVE, ROANOKE, VA 24018-3436
(540) 961-1230
(540) 951-0613
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
119003189
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7156232
AETNA
VA
Enumeration date
01/30/2007
Last updated
09/24/2009
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