Active NPI
Lacey Michelle Medlin, COTA/L
- Occupational Therapy Assistant
- Uniontown, AR
National Provider Identifier
1740753623
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- OT-A1434
- Practice address
- 5112 Harrington Drive
Uniontown, AR 72955-6932 - Phone
- (479) 719-0906
- NPI assigned
- Jan 3, 2019
- Last updated
- May 2, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | OT-A1434 | AR | Primary |
Addresses
Primary practice location
5112 Harrington Drive
Uniontown, AR 72955-6932
Mailing address
2207 Park Ave
Van Buren, AR 72956-6932
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT-A1434 | AR | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Adair Ya, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1546473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714608000000",
"number": "1740753623",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2207 PARK AVE",
"city": "VAN BUREN",
"state": "AR",
"postal_code": "729566932"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5112 HARRINGTON DRIVE",
"city": "UNIONTOWN",
"state": "AR",
"postal_code": "729556932",
"telephone_number": "479-719-0906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDLIN",
"first_name": "LACEY",
"middle_name": "MICHELLE",
"credential": "COTA/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-01-03",
"last_updated": "2024-05-02",
"certification_date": "2024-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "AR",
"license": "OT-A1434",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Uniontown, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.