Provider Demographics
NPI:1912125014
Name:LOCKWOOD, ANN MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 681
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-0681
Mailing Address - Country:US
Mailing Address - Phone:660-853-8348
Mailing Address - Fax:
Practice Address - Street 1:1202 HEARTLAND RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3492
Practice Address - Country:US
Practice Address - Phone:816-671-8506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005030710174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist