Individual
MISS CODY MARIA LACKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1176 WEHR RD, BROOKVILLE, IN 47012-9227
(812) 776-4226
Mailing address
1176 WEHR RD, BROOKVILLE, IN 47012-9227
(812) 776-4226
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA-04119
OH
Other
Enumeration date
12/30/2010
Last updated
12/30/2010
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