Provider Demographics
NPI:1437495488
Name:SIMS, LACEY R (OTR)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:R
Last Name:SIMS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 N WASHINGTON AVE STE 4000
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1776
Mailing Address - Country:US
Mailing Address - Phone:214-820-7457
Mailing Address - Fax:214-820-1654
Practice Address - Street 1:411 N WASHINGTON AVE STE 4000
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1776
Practice Address - Country:US
Practice Address - Phone:214-820-7457
Practice Address - Fax:214-820-1654
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113010225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand