Provider Demographics
NPI:1407536725
Name:BLEVINS, LACEY BREE LASHLEY (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:BREE LASHLEY
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:LACEY
Other - Middle Name:BREE
Other - Last Name:LASHLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:805 N ANTHONY ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-3908
Mailing Address - Country:US
Mailing Address - Phone:918-869-1191
Mailing Address - Fax:
Practice Address - Street 1:611 S COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-6222
Practice Address - Country:US
Practice Address - Phone:918-686-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2066225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist