Individual
MCKENNA LACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2927 S FISH HATCHERY RD, FITCHBURG, WI 53711-6498
(608) 819-6394
Mailing address
119 CHAFFEE RD APT 102, OCONOMOWOC, WI 53066-5710
(608) 556-1363
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
8708-26
WI
Other
Enumeration date
08/05/2024
Last updated
08/20/2024
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