Provider Demographics
NPI:1780763334
Name:CHAFFIN-HICKERSON, LAKISHA DESHAWNDA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LAKISHA
Middle Name:DESHAWNDA
Last Name:CHAFFIN-HICKERSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:LAKISHA
Other - Middle Name:DESHAWNDA
Other - Last Name:CHAFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2200 BERGQUIST DR STE 1
Mailing Address - Street 2:DEPARTMENT OF OCCUPATIONAL THERAPY, WHMC
Mailing Address - City:LACKLAND A F B
Mailing Address - State:TX
Mailing Address - Zip Code:78236-9908
Mailing Address - Country:US
Mailing Address - Phone:210-292-5253
Mailing Address - Fax:210-292-7991
Practice Address - Street 1:2200 BERGQUIST DR STE 1
Practice Address - Street 2:DEPARTMENT OF OCCUPATIONAL THERAPY, WHMC
Practice Address - City:LACKLAND A F B
Practice Address - State:TX
Practice Address - Zip Code:78236-9908
Practice Address - Country:US
Practice Address - Phone:210-292-5253
Practice Address - Fax:210-292-7991
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111666171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider