Provider Demographics
NPI:1043555238
Name:GUNN, LAKESHA REED (OT)
Entity type:Individual
Prefix:
First Name:LAKESHA
Middle Name:REED
Last Name:GUNN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:LAKESHA
Other - Middle Name:
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:6320 N QUAIL HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-1420
Mailing Address - Country:US
Mailing Address - Phone:901-761-0021
Mailing Address - Fax:
Practice Address - Street 1:5469 SOUTHWOOD DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-1928
Practice Address - Country:US
Practice Address - Phone:901-761-0021
Practice Address - Fax:901-432-5215
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2387225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2387OtherHEALTH RELATED BOAR