Healthcare Provider Details

I. General information

NPI: 1124735493
Provider Name (Legal Business Name): LAKIN PRATT RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 BAY SHORE DR
SAINT CLOUD FL
34771-9570
US

IV. Provider business mailing address

335 OAKHURST CIR
KISSIMMEE FL
34744-4753
US

V. Phone/Fax

Practice location:
  • Phone: 623-628-5037
  • Fax:
Mailing address:
  • Phone: 425-512-1194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: