Provider Demographics
NPI:1962839456
Name:FRAZIER-WALLACE, LUCY (OT)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:FRAZIER-WALLACE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2498 DAYTON XENIA RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-7169
Mailing Address - Country:US
Mailing Address - Phone:937-427-1919
Mailing Address - Fax:937-427-1949
Practice Address - Street 1:2498 DAYTON XENIA RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-7169
Practice Address - Country:US
Practice Address - Phone:937-427-1919
Practice Address - Fax:937-427-1949
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT000006225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist