Provider Demographics
NPI:1750922258
Name:VAUGHN, LAKIN (OTR)
Entity type:Individual
Prefix:MRS
First Name:LAKIN
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:LAKIN
Other - Middle Name:
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:4809 FM 2280
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76031-7917
Mailing Address - Country:US
Mailing Address - Phone:512-751-7885
Mailing Address - Fax:
Practice Address - Street 1:6940 HARRIS PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4253
Practice Address - Country:US
Practice Address - Phone:817-289-5960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-05
Last Update Date:2019-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120231225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist