Provider Demographics
NPI:1689933186
Name:KING, MONIQUE LAKRISHA (OTR)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:LAKRISHA
Last Name:KING
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 1:170 MOCKINGBIRD DR
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-2053
Mailing Address - Country:US
Mailing Address - Phone:318-655-0211
Mailing Address - Fax:
Practice Address - Street 1:170 MOCKINGBIRD DR
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2053
Practice Address - Country:US
Practice Address - Phone:318-655-0211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121376225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist