Individual provider Active NPI

Gloria R Lucker, OTR/L

  • Occupational Therapist
  • Buffalo, NY
National Provider Identifier
1396833349
Registry record updated Mar 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
000209-1 Issued in NY
Practice address
2495 Main St
Suite 234
Buffalo, NY 14214-2152
Phone
(716) 836-5929
Fax
(716) 836-6057
NPI assigned
Oct 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 000209-1 NY Primary
Pediatric Occupational Therapist 225XP0200X 00209-1 NY

Addresses

Primary practice location

2495 Main St
Suite 234
Buffalo, NY 14214-2152

Mailing address

2495 Main St
Suite 234
Buffalo, NY 14214-2152
Phone (716) 836-5929

Other identifiers 2

IdentifierTypeStateIssuer
01807827MedicaidNY
000670000002OtherNYCOMMUNITY BLUE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209NYMDMarriage & Family Therapist
000209-1NYMDOccupational Therapist
00209-1NYMDPediatric Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Optimal Occupational and Physical Therapy Associates Services PLLC Occupational Therapist PastSince Apr 15, 2008 Accepting new patients
Optimal Therapy Associates Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206921600000",
    "number": "1396833349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2495 MAIN ST",
            "address_2": "SUITE 234",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142142152",
            "telephone_number": "716-836-5929",
            "fax_number": "716-836-6057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2495 MAIN ST",
            "address_2": "SUITE 234",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142142152",
            "telephone_number": "716-836-5929",
            "fax_number": "716-836-6057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCKER",
        "first_name": "GLORIA",
        "middle_name": "R",
        "name_prefix": "Ms.",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-11",
        "last_updated": "2008-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "000209-1",
            "primary": true
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NY",
            "license": "00209-1",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01807827",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMUNITY BLUE",
            "identifier": "000670000002",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.