Provider Demographics
NPI:1821147182
Name:WAPLE, LIZZ LACKEY (COTAL)
Entity Type:Individual
Prefix:MRS
First Name:LIZZ
Middle Name:LACKEY
Last Name:WAPLE
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:MRS
Other - First Name:LIZZ
Other - Middle Name:LACKEY
Other - Last Name:WAPLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA/L
Mailing Address - Street 1:1115 JODI CIR SE
Mailing Address - Street 2:
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-3390
Mailing Address - Country:US
Mailing Address - Phone:256-303-7090
Mailing Address - Fax:
Practice Address - Street 1:300 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MOULTON
Practice Address - State:AL
Practice Address - Zip Code:35650
Practice Address - Country:US
Practice Address - Phone:256-974-1146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2698224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant