Provider Demographics
NPI:1689033128
Name:BURCHETT, LACEY ERIN (OTR)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:ERIN
Last Name:BURCHETT
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 1:127 SW 156TH ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2515
Mailing Address - Country:US
Mailing Address - Phone:253-216-0720
Mailing Address - Fax:253-854-7025
Practice Address - Street 1:127 SW 156TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2515
Practice Address - Country:US
Practice Address - Phone:253-216-0729
Practice Address - Fax:253-854-7025
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
WAOT60638382225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist