Provider Demographics
NPI:1619451614
Name:LACKER, ALLISON LEE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:LEE
Last Name:LACKER
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 1:500 E BEAR BLVD APT B
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65806-3582
Mailing Address - Country:US
Mailing Address - Phone:636-614-9543
Mailing Address - Fax:
Practice Address - Street 1:567 N AND SOUTH RD APT C
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-3939
Practice Address - Country:US
Practice Address - Phone:314-380-3088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022010049225X00000X
MORBT-17-41531106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty