Individual
MR. LUKAS WAVRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MOTR/L
Contact information
Practice address
1020 LARK ST, ALEXANDRIA, MN 56308-2219
(320) 759-5062
Mailing address
1109 LARK ST APT 104, ALEXANDRIA, MN 56308-2332
(218) 686-3426
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
104542
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104542
MN OCCUPATIONAL THERAPY LICENSE
MN
01
—
303564
NATIONAL BOARD FOR CERTIFICATIOM IN OCCUPATIONAL THERAPY, INC.
MN
Enumeration date
02/03/2016
Last updated
02/03/2016
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