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NPI Code Detail

MEDICARE: OLIVIA ROSE LACY

MEDICARE: OLIVIA ROSE LACY
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
1106S00000XBehavior TechnicianMI

General Provider Information

NPI Number : 1992494157
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLIVIA ROSE LACY
Provider Business Mailing Address
First Line : 1500 S DOUGLAS RD STE 230
Second Line :
City : CORAL GABLES
State : FL
Zip : 33134-4108
Country : US
Telephone Number : 844-244-1818
Fax Number :
Provider Business Practice Location Address
First Line : 517 E DIVISION ST
Second Line :
City : ROCKFORD
State : MI
Zip : 49341-1376
Country : US
Telephone Number : 616-512-2831
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2023
Last Update Date : 04/21/2026

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Directions to “ OLIVIA ROSE LACY ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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