Provider Demographics
NPI:1477831733
Name:HEZEL, LINDSEY JADE
Entity Type:Individual
Prefix:MS
First Name:LINDSEY
Middle Name:JADE
Last Name:HEZEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 PALM COAST PKWY SW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4776
Mailing Address - Country:US
Mailing Address - Phone:386-597-2820
Mailing Address - Fax:386-597-2820
Practice Address - Street 1:397 PALM COAST PKWY SW
Practice Address - Street 2:SUITE 1
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4776
Practice Address - Country:US
Practice Address - Phone:386-597-2820
Practice Address - Fax:386-597-2820
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 11374224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant