Active NPI
Mary Luckini
- Occupational Therapist
- Charles Town, WV
National Provider Identifier
1851804546
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 1737
- Practice address
- 110 Mordington Ave
Charles Town, WV 25414-1693 - Phone
- (304) 267-3595
- Fax
- (304) 267-3599
- NPI assigned
- Nov 16, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 1737 | WV | Primary |
Addresses
Primary practice location
110 Mordington Ave
Charles Town, WV 25414-1693
Mailing address
Jefferson County Board of Education
110 Mordington Avenue
Charles Town, WV 25414
Phone (304) 267-3595
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1737 | Other | WV | WV BOARD OF EXAMINERS CARD |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1737 | WV | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jefferson County Board of Education | Past | Accepting new patients | |
| Jefferson County Schools | 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 and National Provider Directory roles.
-
- Local Education Agency (LEA)
- Charles Town, WV
- NPI 1750550570
-
- Local Education Agency (LEA)
- Charles Town, WV
- NPI 1639367402
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1510790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529107200000",
"number": "1851804546",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "JEFFERSON COUNTY BOARD OF EDUCATION",
"address_2": "110 MORDINGTON AVENUE",
"city": "CHARLES TOWN",
"state": "WV",
"postal_code": "25414",
"telephone_number": "304-267-3595",
"fax_number": "304-267-3599"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 MORDINGTON AVE",
"city": "CHARLES TOWN",
"state": "WV",
"postal_code": "254141693",
"telephone_number": "304-267-3595",
"fax_number": "304-267-3599"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUCKINI",
"first_name": "MARY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-11-16",
"last_updated": "2018-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WV",
"license": "1737",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WV BOARD OF EXAMINERS CARD",
"identifier": "1737",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charles Town, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.