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NPI Code Detail

MEDICARE: LACEY ROBERSON

MEDICARE: LACEY ROBERSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist6997AL

General Provider Information

NPI Number : 1043148836
Entity Type Code : Individual
Provider Name (Legal Business Name) : LACEY ROBERSON
Provider Business Mailing Address
First Line : 695 MOUNTAIN HOME LOOP
Second Line :
City : CEDARTOWN
State : GA
Zip : 30125-4237
Country : US
Telephone Number : 706-767-3085
Fax Number :
Provider Business Practice Location Address
First Line : 3803 RAINBOW DR
Second Line :
City : RAINBOW CITY
State : AL
Zip : 35906-3025
Country : US
Telephone Number : 706-767-3085
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2026
Last Update Date : 05/12/2026

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