Provider Demographics
NPI:1083487284
Name:BURGESS, LINDSAY MAUREEN (COTA/L)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:MAUREEN
Last Name:BURGESS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:MAUREEN
Other - Last Name:PRATER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4525 CENTRAL SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-7113
Mailing Address - Country:US
Mailing Address - Phone:636-851-5700
Mailing Address - Fax:
Practice Address - Street 1:4525 CENTRAL SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-7113
Practice Address - Country:US
Practice Address - Phone:636-851-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004033312224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant