Individual
LARRY EDWIN LICHEY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
25507 VELVET ROSE, SAN ANTONIO, TX 78260-2491
(210) 218-4897
Mailing address
25507 VELVET ROSE, SAN ANTONIO, TX 78260-2491
(210) 218-4897
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
215748
TX
Other
Enumeration date
02/11/2021
Last updated
02/11/2021
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