MEDICARE: LACEY PRECURE OT

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	114060	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376836213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACEY PRECURE OT

Provider Business Mailing Address
First Line	:	4601 66TH ST STE D
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79414-4875
Country	:	US
Telephone Number	:	806-793-3900
Fax Number	:	806-793-3937

Provider Business Practice Location Address
First Line	:	4601 66TH ST STE D
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79414-4875
Country	:	US
Telephone Number	:	806-793-3900
Fax Number	:	806-793-3937

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

Provider Enumeration Date	:	05/25/2011
Last Update Date	:	08/18/2014

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Directions to “ LACEY PRECURE OT” Practice Location

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