Provider Demographics
NPI:1003221805
Name:ARNOLD, LUCY ANN (COTA/L)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:ANN
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10743 W. 10 1/2 RD.
Mailing Address - Street 2:P.O. BOX 459
Mailing Address - City:MESICK
Mailing Address - State:MI
Mailing Address - Zip Code:49668
Mailing Address - Country:US
Mailing Address - Phone:734-341-4352
Mailing Address - Fax:
Practice Address - Street 1:10743 W. 10 1/2 RD.
Practice Address - Street 2:
Practice Address - City:MESICK
Practice Address - State:MI
Practice Address - Zip Code:49668
Practice Address - Country:US
Practice Address - Phone:734-341-4352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202007651224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant