Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 104924 | TX |
NPI | 1205101235 |
---|---|
Provider Name | Mrs. Karen Kay Lacy |
First Address | Fort Worth, TX 76132-3921 |
Second Address | Fort Worth, TX 76132-3921 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2012 |
Last Update Date | 08/03/2012 |