Individual
DR. LACY LEE GARDNER-HATTAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD, OTR/L, C/NDT
Contact information
Practice address
922 GA HIGHWAY 18 W, GRAY, GA 31032-3734
(478) 986-8527
Mailing address
922 GA HIGHWAY 18 W, GRAY, GA 31032-3734
(478) 986-8527
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT005050
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
573697931D
—
GA
Enumeration date
03/29/2010
Last updated
03/13/2020
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