Provider Demographics
NPI:1437672698
Name:FISHER, LACIE (COTA)
Entity Type:Individual
Prefix:MS
First Name:LACIE
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:LACIE
Other - Middle Name:
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:2512 PIONEER LN
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-4116
Mailing Address - Country:US
Mailing Address - Phone:405-412-7802
Mailing Address - Fax:
Practice Address - Street 1:3030 NW EXPWY STE 809
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5466
Practice Address - Country:US
Practice Address - Phone:866-848-8813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1527224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant