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General NPI Number Information
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NPI Number | 1255900346
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Entity Type | Individual
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Provider Name | LACEY ANN ZIMMERMANN OTR/L
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Gender | Female
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Dates
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Enumeration Date | 06/22/2021
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Last Update Date | 06/22/2021
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Provider Practice Location Address
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Address Line | 4554 FORESTDALE DR UNIT E26
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City | PARK CITY
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State | UT
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Zip | 84098-1394
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Country | US
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Telephone | 435-400-4064
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Fax |
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Provider Business Mailing Address
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Address Line | N15W30191 TIMBER BROOK RD
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City | PEWAUKEE
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State | WI
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Zip | 53072-6100
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Country | US
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Telephone | 262-344-4077
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 12326180-4201
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License Number State | UT
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