Individual
LACEY BASCOM REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1165 E 300 N, PROVO, UT 84606-3539
(801) 852-4525
Mailing address
1165 E 300 N, PROVO, UT 84606-3539
(801) 852-4525
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
8428814-4201
UT
Other
Enumeration date
07/22/2010
Last updated
05/02/2023
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