Provider Demographics
NPI:1598212698
Name:CHAPPELL, LACEY (OTR/L)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:CHAPPELL
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 1:3373 STICINE RD
Mailing Address - Street 2:
Mailing Address - City:GUYS
Mailing Address - State:TN
Mailing Address - Zip Code:38339-5236
Mailing Address - Country:US
Mailing Address - Phone:662-415-6581
Mailing Address - Fax:
Practice Address - Street 1:3373 STICINE RD
Practice Address - Street 2:
Practice Address - City:GUYS
Practice Address - State:TN
Practice Address - Zip Code:38339-5236
Practice Address - Country:US
Practice Address - Phone:662-415-6581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2957225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist