Provider Demographics
NPI:1235388596
Name:ROSSER, LACRECIA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LACRECIA
Middle Name:
Last Name:ROSSER
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 1:240 HEDGEROW TRL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7270
Mailing Address - Country:US
Mailing Address - Phone:678-485-9882
Mailing Address - Fax:
Practice Address - Street 1:240 HEDGEROW TRL
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7270
Practice Address - Country:US
Practice Address - Phone:678-485-9882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003321225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA753263090AMedicaid