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Individual

LACEY BROOKE JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MHS, OTR/L

Contact information

Practice address
1501 E GREENVILLE ST, ANDERSON, SC 29621-2004
(864) 226-8356
Mailing address
205 TIARA CT, ANDERSON, SC 29625-2770

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2993
SC

Other

Enumeration date
09/26/2006
Last updated
07/08/2007
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