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NPI Code Detail

MEDICARE: MS. ALLISON LEE LACKER OTR/L

MEDICARE: MS. ALLISON LEE LACKER OTR/L
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 Therapist2022010049MO
2106S00000XBehavior TechnicianRBT-17-41531MO

General Provider Information

NPI Number : 1619451614
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ALLISON LEE LACKER OTR/L
Provider Business Mailing Address
First Line : 500 E BEAR BLVD APT B
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65806-3582
Country : US
Telephone Number : 636-614-9543
Fax Number :
Provider Business Practice Location Address
First Line : 567 N AND SOUTH RD APT C
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63130-3939
Country : US
Telephone Number : 314-380-3088
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2018
Last Update Date : 05/13/2022

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