Provider Demographics
NPI:1164746749
Name:WILKERSON, LACRESHA (LOTR)
Entity Type:Individual
Prefix:
First Name:LACRESHA
Middle Name:
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 TURNBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-5862
Mailing Address - Country:US
Mailing Address - Phone:919-260-8438
Mailing Address - Fax:888-401-0837
Practice Address - Street 1:1140 TURNBRIDGE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-5862
Practice Address - Country:US
Practice Address - Phone:919-260-8438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.200011225X00000X
NC15301225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist