Provider Demographics
NPI:1205101235
Name:LACY, KAREN KAY (OT)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:KAY
Last Name:LACY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:KAY
Other - Last Name:HESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:7277 HAWKINS VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3921
Mailing Address - Country:US
Mailing Address - Phone:817-423-5611
Mailing Address - Fax:817-423-5577
Practice Address - Street 1:7277 HAWKINS VIEW DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3921
Practice Address - Country:US
Practice Address - Phone:817-423-5611
Practice Address - Fax:817-423-5577
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104924225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation