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General NPI Number Information
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NPI Number | 1538614078
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Entity Type | Individual
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Provider Name | LACEY SMITH
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Gender | Female
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Dates
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Enumeration Date | 08/24/2016
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Last Update Date | 08/24/2016
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Provider Practice Location Address
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Address Line | 7726 HIGHWAY 165
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City | COLUMBIA
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State | LA
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Zip | 71418-3322
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Country | US
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Telephone | 318-649-9840
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Fax |
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Provider Business Mailing Address
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Address Line | 4109 HIGHWAY 98 W
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City | SUMMIT
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State | MS
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Zip | 39666-9132
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Country | US
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Telephone | 601-276-3900
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 303410
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License Number State | LA
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