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Individual

MR. LEZERIC ANZEL FALLEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OTA

Contact information

Practice address
1157 S KENTUCKY AVE, EVANSVILLE, IN 47714-2737
(812) 402-0460
Mailing address
1157 S KENTUCKY AVE, EVANSVILLE, IN 47714-2737
(812) 402-0460

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32000566A
IN

Other

Enumeration date
10/18/2012
Last updated
10/18/2012
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