Provider Demographics
NPI:1225205768
Name:WILBORN, LAKISHA SHONTELL (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LAKISHA
Middle Name:SHONTELL
Last Name:WILBORN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 SUNNY DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-2069
Mailing Address - Country:US
Mailing Address - Phone:912-695-0216
Mailing Address - Fax:912-544-7992
Practice Address - Street 1:116 SUNNY DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-2069
Practice Address - Country:US
Practice Address - Phone:912-695-0216
Practice Address - Fax:912-544-7992
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003547225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist