Individual
DAIRITA LUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1586 NORTHRIDGE RD, COLUMBUS, OH 43224-2801
(614) 270-3741
Mailing address
1586 NORTHRIDGE RD, COLUMBUS, OH 43224-2801
(614) 270-3741
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0090104
—
OH
Enumeration date
09/01/2015
Last updated
09/01/2015
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