Individual
LAKENA WIGGINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1759 BROAD PARK CIR S STE 113, MANSFIELD, TX 76063-7836
(817) 473-1312
Mailing address
4320 DULLES DR, FORT WORTH, TX 76155-3550
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
117069
MS
Other
Enumeration date
05/16/2017
Last updated
05/16/2017
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