Provider Demographics
NPI:1053592980
Name:LUEBKE, HOWARD (OT)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:
Last Name:LUEBKE
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 LUCERNE DR
Mailing Address - Street 2:SUITE 405
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-6588
Mailing Address - Country:US
Mailing Address - Phone:419-841-1840
Mailing Address - Fax:419-841-1841
Practice Address - Street 1:3160 CENTRAL PARK W
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1083
Practice Address - Country:US
Practice Address - Phone:419-841-1840
Practice Address - Fax:419-841-1841
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT000355225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2129655Medicaid