Provider Demographics
NPI:1073098398
Name:HARRIS, LACEY (MA, ATC)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA, ATC
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:
Other - Last Name:TOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, ATC
Mailing Address - Street 1:1540 HOMESTEAD WAY
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-1700
Mailing Address - Country:US
Mailing Address - Phone:315-854-0227
Mailing Address - Fax:
Practice Address - Street 1:755 E TULARE AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-4353
Practice Address - Country:US
Practice Address - Phone:559-686-4761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer