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General NPI Number Information
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NPI Number | 1013792795
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Entity Type | Individual
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Provider Name | LACEY MARIE WOODARD
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Gender | Female
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Dates
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Enumeration Date | 08/30/2023
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Last Update Date | 08/30/2023
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Provider Practice Location Address
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Address Line | 1400 SE 4TH ST
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City | MOORE
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State | OK
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Zip | 73160-7329
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Country | US
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Telephone | 405-837-1033
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Fax |
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Provider Business Mailing Address
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Address Line | 1213 FOGGY BOTTOM RD
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City | TECUMSEH
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State | OK
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Zip | 74873-1630
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Country | US
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Telephone | 940-704-5169
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 183717
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License Number State | OK
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