Provider Demographics
NPI:1720719966
Name:LACEE NEIDIGH MOTR LLC
Entity Type:Organization
Organization Name:LACEE NEIDIGH MOTR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LACEE
Authorized Official - Middle Name:MILLICENT
Authorized Official - Last Name:NEIDIGH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:281-224-3833
Mailing Address - Street 1:1461 HAVENBROOK LN
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-0328
Mailing Address - Country:US
Mailing Address - Phone:281-224-3833
Mailing Address - Fax:
Practice Address - Street 1:1461 HAVENBROOK LN
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-0328
Practice Address - Country:US
Practice Address - Phone:281-224-3833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty