Provider Demographics
NPI:1689208407
Name:GARCIA, LACI LEA
Entity Type:Individual
Prefix:
First Name:LACI
Middle Name:LEA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 S TECHNOLOGY BLVD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-5003
Mailing Address - Country:US
Mailing Address - Phone:509-209-7429
Mailing Address - Fax:509-340-9942
Practice Address - Street 1:1515 S TECHNOLOGY BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224
Practice Address - Country:US
Practice Address - Phone:509-209-7429
Practice Address - Fax:509-340-9942
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT61035980225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOT61035980OtherOT LICENSE