Provider Demographics
NPI:1477288843
Name:LOBERG, LINDSEY MICHELLE (COTA)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:MICHELLE
Last Name:LOBERG
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 1:308 SHORE ACRES RD
Mailing Address - Street 2:
Mailing Address - City:LACRESCENT
Mailing Address - State:MN
Mailing Address - Zip Code:55947
Mailing Address - Country:US
Mailing Address - Phone:608-406-1691
Mailing Address - Fax:
Practice Address - Street 1:308 SHORE ACRES RD
Practice Address - Street 2:
Practice Address - City:LACRESCENT
Practice Address - State:MN
Practice Address - Zip Code:55947
Practice Address - Country:US
Practice Address - Phone:608-406-1691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN202700224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant