Provider Demographics
NPI:1114470275
Name:GEISEL, LACIE KENDALL (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:LACIE
Middle Name:KENDALL
Last Name:GEISEL
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E WILSON ST
Mailing Address - Street 2:
Mailing Address - City:WINGATE
Mailing Address - State:NC
Mailing Address - Zip Code:28174-9665
Mailing Address - Country:US
Mailing Address - Phone:410-924-0685
Mailing Address - Fax:
Practice Address - Street 1:315 E WILSON ST
Practice Address - Street 2:
Practice Address - City:WINGATE
Practice Address - State:NC
Practice Address - Zip Code:28174-9665
Practice Address - Country:US
Practice Address - Phone:410-924-0685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer