Provider Demographics
NPI:1437453370
Name:SPENCER, LYNDSY (OTR/L)
Entity Type:Individual
Prefix:
First Name:LYNDSY
Middle Name:
Last Name:SPENCER
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 1:1420 16TH ST SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-2828
Mailing Address - Country:US
Mailing Address - Phone:320-420-4080
Mailing Address - Fax:320-764-2245
Practice Address - Street 1:2120 60TH AVE NE
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-9140
Practice Address - Country:US
Practice Address - Phone:320-214-7082
Practice Address - Fax:320-235-8059
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103917225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist