Individual
CHASITY MARIE LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
363 BUTTERCUP AVE, VANDALIA, OH 45377-1847
(937) 470-2872
Mailing address
363 BUTTERCUP AVE, VANDALIA, OH 45377-1847
(937) 470-2872
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
03/19/2025
Last updated
03/19/2025
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