Basic Information
| Provider Information | |||||||||
| NPI: | 1639640337 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POPICHAK | ||||||||
| FirstName: | LACEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 191 DUBOCE AVE APT 203 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941031167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8312351859 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3400 LAGUNA ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941232271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152020300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2018 | ||||||||
| LastUpdateDate: | 12/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0019X | 19322 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation |
No ID Information.