Provider Demographics
NPI:1275172702
Name:LAKKHAM, WASSAKANIT (LMT, CMMP)
Entity Type:Individual
Prefix:MR
First Name:WASSAKANIT
Middle Name:
Last Name:LAKKHAM
Suffix:
Gender:F
Credentials:LMT, CMMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 ROSEMERE AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-3010
Mailing Address - Country:US
Mailing Address - Phone:202-820-4073
Mailing Address - Fax:
Practice Address - Street 1:1103 ROSEMERE AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-3010
Practice Address - Country:US
Practice Address - Phone:202-820-4073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-01
Last Update Date:2020-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMO5900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist