Individual
MRS. LACEY C RICHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
270 HIGHWAY 3185, THIBODAUX, LA 70301-7466
(985) 449-0944
(985) 449-0945
Mailing address
1101 LEE DR, THIBODAUX, LA 70301-3962
(985) 859-2748
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
200556
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT200556
OT BOARD
LA
Enumeration date
05/23/2013
Last updated
05/08/2014
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