Provider Demographics
NPI:1427663277
Name:RICHARDSON, LAKIEZA CHARIQ (COTA/L)
Entity type:Individual
Prefix:
First Name:LAKIEZA
Middle Name:CHARIQ
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 S MORTON AVE APT A46
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:PA
Mailing Address - Zip Code:19070-2069
Mailing Address - Country:US
Mailing Address - Phone:267-296-0690
Mailing Address - Fax:
Practice Address - Street 1:144 S MORTON AVE APT A46
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:PA
Practice Address - Zip Code:19070-2069
Practice Address - Country:US
Practice Address - Phone:267-296-0690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP009757224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant