Provider Demographics
NPI:1558961797
Name:LOCKETT, MICHEL
Entity Type:Individual
Prefix:
First Name:MICHEL
Middle Name:
Last Name:LOCKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 INGLESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-1359
Mailing Address - Country:US
Mailing Address - Phone:937-581-8417
Mailing Address - Fax:
Practice Address - Street 1:321 INGLESIDE AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-1359
Practice Address - Country:US
Practice Address - Phone:937-581-8417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care