Healthcare Provider Details

I. General information

NPI: 1144719261
Provider Name (Legal Business Name): LACEY GEDDIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 N CENTRAL EXPY STE 225
DALLAS TX
75231-0918
US

IV. Provider business mailing address

1491 CAMPBELL RD
WAXAHACHIE TX
75167-8030
US

V. Phone/Fax

Practice location:
  • Phone: 214-265-0420
  • Fax:
Mailing address:
  • Phone: 903-467-0897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number214636
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: