Provider Demographics
NPI:1497909352
Name:EUBANKS, LINDSAY R (MED, OTR/L, ATP)
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:R
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:MED, OTR/L, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3328 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1016
Mailing Address - Country:US
Mailing Address - Phone:502-494-3656
Mailing Address - Fax:
Practice Address - Street 1:432 E ORMSBY AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2644
Practice Address - Country:US
Practice Address - Phone:502-494-3656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225CA2400X
KYKYR2990225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner