Healthcare Provider Details

I. General information

NPI: 1114733136
Provider Name (Legal Business Name): LAKESHA LYNN CHAPPELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 SOUTHERN HILLS BLVD
HAMILTON OH
45013-3736
US

IV. Provider business mailing address

1200 SOUTHERN HILLS BLVD
HAMILTON OH
45013-3736
US

V. Phone/Fax

Practice location:
  • Phone: 814-218-4620
  • Fax:
Mailing address:
  • Phone: 814-218-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: