Provider Demographics
NPI:1093121311
Name:LUMPKINS, HENRY W JR (OTR)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:W
Last Name:LUMPKINS
Suffix:JR
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4707 W AVENUE K8
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-5136
Mailing Address - Country:US
Mailing Address - Phone:661-435-9416
Mailing Address - Fax:
Practice Address - Street 1:4707 W AVENUE K8
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-5136
Practice Address - Country:US
Practice Address - Phone:661-435-9416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8167225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist