Provider Demographics
NPI:1972094274
Name:LOCKHART, TIA
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 LITTLE KITTEN AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-7545
Mailing Address - Country:US
Mailing Address - Phone:785-776-0065
Mailing Address - Fax:785-776-6825
Practice Address - Street 1:2025 LITTLE KITTEN AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-7545
Practice Address - Country:US
Practice Address - Phone:785-776-0065
Practice Address - Fax:785-776-6825
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00922224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant