Provider Demographics
NPI:1134276843
Name:LUKE-HENRY, GEORGIANA CHEVALIER (OTR)
Entity type:Individual
Prefix:
First Name:GEORGIANA
Middle Name:CHEVALIER
Last Name:LUKE-HENRY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 RUSTIC ARCH WAY
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-3628
Mailing Address - Country:US
Mailing Address - Phone:704-975-2840
Mailing Address - Fax:704-997-8908
Practice Address - Street 1:1646 RUSTIC ARCH WAY
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3628
Practice Address - Country:US
Practice Address - Phone:704-975-2840
Practice Address - Fax:704-997-8908
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7509225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7302306Medicaid