Provider Demographics
NPI:1679712426
Name:SMITH, LAKEISHA MONIQUE I
Entity type:Individual
Prefix:MS
First Name:LAKEISHA
Middle Name:MONIQUE
Last Name:SMITH
Suffix:I
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LAKEISHA
Other - Middle Name:MONIQUE
Other - Last Name:SMITH
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:MSOTR/L,ATP,CLWT
Mailing Address - Street 1:128 CANNONBALL LN
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3096
Mailing Address - Country:US
Mailing Address - Phone:646-234-7608
Mailing Address - Fax:
Practice Address - Street 1:801 N BROOM ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4624
Practice Address - Country:US
Practice Address - Phone:302-654-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU10001217225XP0019X
NY014382-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation