Individual
KIEVANNA LACEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7723 JASPER AVE, JACKSONVILLE, FL 32211-7719
(904) 725-8044
Mailing address
14491 CHERRY LAKE DR E, JACKSONVILLE, FL 32258-5179
(609) 433-3851
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
20032
FL
Other
Enumeration date
11/01/2019
Last updated
11/01/2019
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