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General NPI Number Information
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NPI Number | 1326955691
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Entity Type | Individual
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Provider Name | LACIE STAR DYER
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Gender | Female
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Dates
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Enumeration Date | 08/25/2026
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Last Update Date | 08/25/2026
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Provider Practice Location Address
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Address Line | 601 N E ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92415-0020
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Country | US
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Telephone | 909-888-3228
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Fax |
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Provider Business Mailing Address
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Address Line | 12887 SHOLIC RD
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City | APPLE VALLEY
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State | CA
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Zip | 92308-6894
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Country | US
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Telephone |
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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 | OT29314
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License Number State | CA
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