Provider Demographics
NPI:1346598356
Name:LACKEY, DONA L (LMT)
Entity Type:Individual
Prefix:MISS
First Name:DONA
Middle Name:L
Last Name:LACKEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5036 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64129-1989
Mailing Address - Country:US
Mailing Address - Phone:816-645-6520
Mailing Address - Fax:
Practice Address - Street 1:5036 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64129-1989
Practice Address - Country:US
Practice Address - Phone:816-645-6520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-22
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004000313225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist