Provider Demographics
NPI:1093188146
Name:WILD, LINDSAY TAYLOR (OT)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:TAYLOR
Last Name:WILD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4888 LOOP CENTRAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-2227
Mailing Address - Country:US
Mailing Address - Phone:713-838-9050
Mailing Address - Fax:713-838-0926
Practice Address - Street 1:4888 LOOP CENTRAL DR STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-2227
Practice Address - Country:US
Practice Address - Phone:713-838-9050
Practice Address - Fax:713-838-0926
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117230225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist