Healthcare Provider Details

I. General information

NPI: 1205101235
Provider Name (Legal Business Name): KAREN KAY LACY OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN KAY HESTER OT

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7277 HAWKINS VIEW DR
FORT WORTH TX
76132-3921
US

IV. Provider business mailing address

7277 HAWKINS VIEW DR
FORT WORTH TX
76132-3921
US

V. Phone/Fax

Practice location:
  • Phone: 817-423-5611
  • Fax: 817-423-5577
Mailing address:
  • Phone: 817-423-5611
  • Fax: 817-423-5577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number104924
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: