Provider Demographics
NPI:1073010377
Name:CORMIER, LACEY BETH (OTR/L)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:BETH
Last Name:CORMIER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1457 BEECH HILL RD
Mailing Address - Street 2:
Mailing Address - City:MERCER
Mailing Address - State:ME
Mailing Address - Zip Code:04957-4851
Mailing Address - Country:US
Mailing Address - Phone:207-357-6741
Mailing Address - Fax:
Practice Address - Street 1:119 LIVERMORE FALLS RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-6241
Practice Address - Country:US
Practice Address - Phone:207-778-6591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT2381225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation