Individual
LACEY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
650 EDISON AVE, PHILADELPHIA, PA 19116-1237
(215) 856-5766
Mailing address
650 EDISON AVE, PHILADELPHIA, PA 19116-1237
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OP008943
PA
Other
Enumeration date
03/14/2018
Last updated
03/14/2018
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