Provider Demographics
NPI:1861638215
Name:HARGBOL, LACEY (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:HARGBOL
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 INDUSTRIAL PARK DR
Mailing Address - Street 2:BLDG 2 UNIT 5
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-8520
Mailing Address - Country:US
Mailing Address - Phone:603-223-3330
Mailing Address - Fax:603-437-0431
Practice Address - Street 1:2 INDUSTRIAL PARK DR
Practice Address - Street 2:BLDG 2 UNIT 5
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-8520
Practice Address - Country:US
Practice Address - Phone:603-223-3330
Practice Address - Fax:603-437-0431
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2030225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics