Provider Demographics
NPI:1407458045
Name:IRWIN, LINDSEY (COTA/L)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:IRWIN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4108 HIGHWAY T
Mailing Address - Street 2:
Mailing Address - City:MARTHASVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63357-2022
Mailing Address - Country:US
Mailing Address - Phone:636-357-8428
Mailing Address - Fax:
Practice Address - Street 1:313 AUGUSTINE RD
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-1935
Practice Address - Country:US
Practice Address - Phone:636-938-6770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019010110224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant