Individual
LACY ROSE MILES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
415 S 1ST ST STE 300A, LUFKIN, TX 75901-3863
(936) 225-1174
Mailing address
204 PRICE ST, MARSHALL, TX 75670-3523
(903) 742-1997
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
216015
TX
Other
Enumeration date
11/21/2019
Last updated
11/21/2019
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