Provider Demographics
NPI:1023817160
Name:WILKES-BARCLAY, LORA GENEEN
Entity type:Individual
Prefix:
First Name:LORA
Middle Name:GENEEN
Last Name:WILKES-BARCLAY
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 1:1179 WINTON AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-3660
Mailing Address - Country:US
Mailing Address - Phone:330-906-4786
Mailing Address - Fax:
Practice Address - Street 1:1179 WINTON AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-3660
Practice Address - Country:US
Practice Address - Phone:330-906-4786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHQF120790347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle