Provider Demographics
NPI:1255900346
Name:ZIMMERMANN, LACEY ANN (OTR/L)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:ANN
Last Name:ZIMMERMANN
Suffix:
Gender:F
Credentials: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:N15W30191 TIMBER BROOK RD
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-6100
Mailing Address - Country:US
Mailing Address - Phone:262-344-4077
Mailing Address - Fax:
Practice Address - Street 1:4554 FORESTDALE DR UNIT E26
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-1394
Practice Address - Country:US
Practice Address - Phone:435-400-4064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12326180-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist