Provider Demographics
NPI:1487020657
Name:MCCOMBS, LACEY (BS)
Entity Type:Individual
Prefix:MS
First Name:LACEY
Middle Name:
Last Name:MCCOMBS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 W 78TH ST APT 207
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-4600
Mailing Address - Country:US
Mailing Address - Phone:580-362-0222
Mailing Address - Fax:
Practice Address - Street 1:1611 W 78TH ST APT 207
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-4600
Practice Address - Country:US
Practice Address - Phone:580-362-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer