Individual
MARVIN LACEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
10133 SHERRILL BLVD, KNOXVILLE, TN 37932-3347
(929) 342-0706
Mailing address
2560 KEY ST APT 4L, TOLEDO, OH 43614-4818
(419) 917-2322
Taxonomy
Speciality
Code
Description
License number
State
224ZE0001X
Environmental Modification Occupational Therapy Assistant
Primary
0625
—
Other
Enumeration date
12/05/2022
Last updated
12/05/2022
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