Individual
LACY BUSSEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
700 N COURTENAY PKWY APT 527, MERRITT ISLAND, FL 32953-5401
(321) 750-8447
Mailing address
700 N COURTENAY PKWY APT 527, MERRITT ISLAND, FL 32953-5401
(321) 750-8447
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Enumeration date
03/18/2020
Last updated
03/18/2020
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