Individual
KAITLIN LACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
105 GLENDALOUGH COURT, SUITE H, TYRONE, GA 30290
(678) 632-6765
(678) 550-7931
Mailing address
117 HARDY ROAD, SENOIA, GA 30267
(678) 371-1061
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT006357
GA
Other
Enumeration date
02/19/2016
Last updated
02/19/2016
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