Provider Demographics
NPI:1255826400
Name:PANCOAST, LINDSAY LONG (OTR/L)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:LONG
Last Name:PANCOAST
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 W END CIR APT 8
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1124
Mailing Address - Country:US
Mailing Address - Phone:610-420-8771
Mailing Address - Fax:
Practice Address - Street 1:504 ELMINGTON AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2508
Practice Address - Country:US
Practice Address - Phone:615-292-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5923225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGIL827M95712OtherCOBRA