Provider Demographics
NPI:1053188516
Name:ROBBINS, LACI NICOLE (COTA/L)
Entity type:Individual
Prefix:
First Name:LACI
Middle Name:NICOLE
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9125 E VAN HOOK ST APT C
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-5562
Mailing Address - Country:US
Mailing Address - Phone:731-420-4681
Mailing Address - Fax:
Practice Address - Street 1:8017 DOGWOOD LN
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-6805
Practice Address - Country:US
Practice Address - Phone:731-686-8373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3734224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant