Provider Demographics
NPI:1225915366
Name:LACOMBE, MAISA
Entity type:Individual
Prefix:
First Name:MAISA
Middle Name:
Last Name:LACOMBE
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 1:207 BENTON ST
Mailing Address - Street 2:
Mailing Address - City:ROSSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60963-1002
Mailing Address - Country:US
Mailing Address - Phone:217-495-1774
Mailing Address - Fax:
Practice Address - Street 1:3220 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-7921
Practice Address - Country:US
Practice Address - Phone:217-431-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant