Provider Demographics
NPI:1184399420
Name:MARTINEZ, LACEY BLANCHARD (LOTR)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:BLANCHARD
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 SPRINGWATER DR
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-4796
Mailing Address - Country:US
Mailing Address - Phone:337-552-1147
Mailing Address - Fax:
Practice Address - Street 1:309 SPRINGWATER DR
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-4796
Practice Address - Country:US
Practice Address - Phone:337-552-1147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist