MEDICARE: MRS. ALICIA C. LACAMBRA OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	103495	TX

General Provider Information

NPI Number	:	1275765299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALICIA C. LACAMBRA OTR

Provider Business Mailing Address
First Line	:	3000 N DANVILLE ST
Second Line	:
City	:	WILLIS
State	:	TX
Zip	:	77378-3490
Country	:	US
Telephone Number	:	936-856-4312
Fax Number	:	936-856-4364

Provider Business Practice Location Address
First Line	:	3000 N DANVILLE ST
Second Line	:
City	:	WILLIS
State	:	TX
Zip	:	77378-3490
Country	:	US
Telephone Number	:	936-856-4312
Fax Number	:	936-856-4364

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2009
Last Update Date	:	08/10/2009

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