Provider Demographics
NPI:1952653420
Name:FRAZIER, LACIE LEANN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:LACIE
Middle Name:LEANN
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6048 GRAYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-1158
Mailing Address - Country:US
Mailing Address - Phone:419-913-9390
Mailing Address - Fax:
Practice Address - Street 1:5107 MONROE ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3429
Practice Address - Country:US
Practice Address - Phone:419-913-9390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.019939225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist