Provider Demographics
NPI:1306188982
Name:OSGOOD, LACEY DAY (MOTR/L)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:DAY
Last Name:OSGOOD
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4983 CHIMNEY ROCK DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83406-8120
Mailing Address - Country:US
Mailing Address - Phone:208-524-3514
Mailing Address - Fax:
Practice Address - Street 1:690 JOHN ADAMS PKWY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4073
Practice Address - Country:US
Practice Address - Phone:208-525-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2526225X00000X
IDOT665225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist