Provider Demographics
NPI:1447618392
Name:WILKINSON, LAMAR ADRIAN (LMT)
Entity Type:Individual
Prefix:
First Name:LAMAR
Middle Name:ADRIAN
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 W NORTH BEND RD APT 11
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-7719
Mailing Address - Country:US
Mailing Address - Phone:513-501-1189
Mailing Address - Fax:
Practice Address - Street 1:2741 W NORTH BEND RD APT 11
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-7719
Practice Address - Country:US
Practice Address - Phone:513-501-1189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-07
Last Update Date:2016-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.022151225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist