Provider Demographics
NPI:1306005210
Name:LINGHOLM, JEANETTE ANN (COTA)
Entity Type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:ANN
Last Name:LINGHOLM
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 NW 8TH CT
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-3508
Mailing Address - Country:US
Mailing Address - Phone:561-369-5420
Mailing Address - Fax:
Practice Address - Street 1:510 NW 8TH CT
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3508
Practice Address - Country:US
Practice Address - Phone:561-369-5420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA9423224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant