Individual
MARY LUCKINI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
110 MORDINGTON AVE, CHARLES TOWN, WV 25414-1693
(304) 267-3595
(304) 267-3599
Mailing address
JEFFERSON COUNTY BOARD OF EDUCATION, 110 MORDINGTON AVENUE, CHARLES TOWN, WV 25414
(304) 267-3595
(304) 267-3599
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1737
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1737
WV BOARD OF EXAMINERS CARD
WV
Enumeration date
11/16/2017
Last updated
06/16/2018
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