Individual
TAYLOR NICOLE LUSK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1436 CENTRAL AVE E, WIGGINS, MS 39577-9602
(601) 928-1889
Mailing address
254 PARSONAGE DR, DANIELS, WV 25832-9687
(304) 575-1594
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
2129
WV
225X00000X
Occupational Therapist
Primary
OT-3859
MS
Other
Enumeration date
08/04/2021
Last updated
08/04/2021
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