Provider Demographics
NPI:1609433879
Name:LAWRENCE, ALICE M
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:M
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 W LOGAN ST STE A
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-2000
Mailing Address - Country:US
Mailing Address - Phone:419-586-1333
Mailing Address - Fax:419-586-1333
Practice Address - Street 1:913 W LOGAN ST STE A
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-2000
Practice Address - Country:US
Practice Address - Phone:419-586-1333
Practice Address - Fax:419-586-1333
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.018938225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist