Provider Demographics
NPI:1871254979
Name:THOMAS, LAKEISHA RENEE (DODD)
Entity Type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:RENEE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DODD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-4326
Mailing Address - Country:US
Mailing Address - Phone:513-464-3345
Mailing Address - Fax:
Practice Address - Street 1:1500 1ST AVE APT 2
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-4185
Practice Address - Country:US
Practice Address - Phone:513-464-3345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-01
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0907006385H00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty