Individual
LACY MARIE BEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
104 ENTERPRISE AVE, DEVINE, TX 78016-1807
(830) 663-4451
Mailing address
8843 STAGHORN ML, CONVERSE, TX 78109-3754
(760) 315-5235
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
215055
TX
Other
Enumeration date
08/23/2018
Last updated
08/23/2018
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