Provider Demographics
NPI:1467578450
Name:LANKFORD, ROSHONDA DENISE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ROSHONDA
Middle Name:DENISE
Last Name:LANKFORD
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 1:208 39TH CT
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-1331
Mailing Address - Country:US
Mailing Address - Phone:601-480-1346
Mailing Address - Fax:
Practice Address - Street 1:1502 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:AL
Practice Address - Zip Code:36744-1552
Practice Address - Country:US
Practice Address - Phone:601-581-1191
Practice Address - Fax:334-624-3960
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1536225X00000X
AL2156225X00000X
GAOT006440225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890016800Medicaid
AL146409Medicaid
AL890016800Medicaid