Individual
MS. LACY RENEE DORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1105 ROCK PRAIRIE RD, COLLEGE STATION, TX 77845-8344
(979) 694-2200
Mailing address
806 SAN PEDRO DR APT A, COLLEGE STATION, TX 77845-6643
(816) 810-6803
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
TX
Other
Enumeration date
10/23/2019
Last updated
10/23/2019
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